Heart to Heart Hospice Criteria for Hospice Care

In 2018, over 1.5 million individuals with Medicare coverage received hospice care. This large number does not reflect hospice care recipients with alternative health care coverage.

If you or a loved one are living with a life-threatening condition, you may be wondering if and when it is time for hospice care. It is important to recognize that hospice care is not the right choice for all patients, and that there are certain criteria that must qualify a patient for hospice care.

What, exactly, is the criteria for hospice care? How can you determine whether or not it’s time to request hospice services?

Who Is Hospice Care For?

Hospice care is a compassion-forward approach to providing care for patients suffering from life-limiting illnesses. The objective of hospice care is to provide comfort and holistic treatment to maintain a high quality of life for hospice patients.

Hospice treatment is not the same as typical medical treatments. When a patient enters the phase of life that may require hospice care, they are no longer seeking curative treatments  for their illness. Instead, the medical treatment associated with hospice care focuses more on things like pain management and symptom relief.

Hospice care is mainly provided in the place a patient calls ‘home’. This may be a private residence, a family member’s residence, or an assisted living community. Wherever a patient sleeps, wakes, and spends their days is where a hospice caregiver will provide them with treatment.

Ultimately, hospice care does not hasten a patient’s passing. Instead, it ensures a comfortable and peaceful transition for the last weeks or months of a patient’s life. In fact, a study published in the Journal of Pain and Symptom Management found that some patients live longer on hospice, on average 29 days longer. {Journal of Pain and Symptom Management Vol. 33 No. 3 March 2007}

Breaking Down the Criteria for Hospice Care

How do you know when it’s time for hospice care? There are specific criteria a patient must meet in order to qualify for hospice care. Let’s take a closer look at what they are.

General Requirements

General requirements speak to a patient’s overall condition. Typically, a patient will need to meet one or several of the following criteria based on a doctor’s professional assessment. These criteria include:

  • The diagnosis of a life-limiting condition and has a prognosis of six months or less to live assuming that the illness runs its predicted course
  • An increase or a high number of hospitalizations in the previous six months
  • Increased and continuous weight loss
  • Frequent bouts of weakness, somnolence, or fatigue
  • Changes in cognitive and/or functional abilities
  • Difficulty with ADLs (activities of daily living) including grooming, dressing, bathing, eating, cleaning, walking, using the restroom, and so forth
  • Worsening mental abilities
  • Breakdown of the skin
  • Increase or recurrence of infections
  • Disease-specific decline

In some cases, more than one factor will need to be present in a patient in order to qualify for hospice care. For example, some patients may have difficulty with ADLs but do not fit any of the other criteria.

It is also worth noting that hospice care may continue longer than six months if the initial prognosis was inaccurate. In rare cases, patients may be referred for a change in the type of care they receive. (For example, if a patient’s condition improves, they may seek traditional care in   place of hospice care.)

Disease-Specific Requirements

Not all conditions are considered life-limiting. Common conditions that lead to hospice care eligibility include (but are not limited to) the following:

  • All types of cancer
  • Cerebral vascular accident or stroke
  • Congestive heart failure or cardiopulmonary disease
  • COPD
  • End Stage Dementia
  • Liver disease
  • Non-dementia neurological conditions (e.g. ALS, Huntington’s disease, Multiple Sclerosis, or Parkinson’s disease)
  • Renal disease

Once again, it is important to note that the presence, alone, of one or multiple conditions on this list does not automatically qualify a patient for hospice care. It is only when treatment is no longer preventing decline that hospice care becomes necessary or useful.

Accepted Health Care Options

If you qualify for hospice care, you can cover or reduce the cost using your health care. Accepted health care options include:

  • Medicare
  • Medicaid
  • VA benefits
  • Most private insurance providers
  • Self Pay

You may need to speak with a health care representative to find out more about coverage.

Your health insurance provider may also have their own set of criteria that differ slightly from ours. However, most insurance providers use the same criteria as what we have listed here in this guide.

Is Hospice Care Right for You or Your Loved One?

Struggling with a life-limiting condition can be physically and emotionally difficult. Hospice care providers make your final months far more comfortable by providing a range of care, including pain management and symptom management. Now that you know more about the criteria for hospice care, you can make an informed decision about whether or not hospice care is right for you or your loved one. Heart to Heart Hospice provides high-quality hospice care in a number of Texas, Indiana, and Michigan counties. Find hospice care services nearest you or your loved one. If you have any questions about our services, contact us today.