Caring for a patient with a terminal illness is difficult enough for families, and involving hospice care means creating a support system for medical, emotional, spiritual, psychosocial and practical needs. One of the most frequent questions we receive is “How do I know if my loved one qualifies for hospice care?”
Life Expectancy and Doctor’s Approval
To qualify for hospice care, a patient must have a terminal illness with a life expectancy of six months or less should the illness run its normal course. This must be certified by the patient’s doctor (if they have one) and a hospice doctor.
Under hospice, patients agree to only receive comfort care (called palliative care) instead of pursuing treatment or a cure related to their illness. Starting hospice as early as possible helps ensure that the patient and family receive the maximum benefit allowed.
Hospice care is not for patients who are still pursuing treatments for their illness. Comfort care under hospice includes managing pain and symptoms so patients can live as comfortably and fully as possible for their remaining days. Hospice patients can seek treatment for medical needs unrelated to their terminal illness, such as a broken bone.
Patient Responsibility — Choice and Coverage
The patient, when possible, must sign a statement accepting hospice care and agreeing to forgo any curative treatments for their illness and related conditions. If the patient is physically or mentally incapacitated, an authorized representative may file to elect for hospice coverage.
Medicare, Medicaid, VA benefits, and many private insurance plans provide hospice care coverage. According to the Hospice Foundation of America: Most hospice patients are eligible for Medicare, which covers all aspects of hospice care and coverage with no deductible. Some small copayments may be required for prescriptions and respite care.
Hospice patients have the right to choose (or change) their hospice provider. Much of hospice care is provided in the home, in a long-term care facility that is considered “home” to the patient, and more rarely, in a specified hospice center.
Patient Status — Extensions or Improvements
At times, a hospice patient’s condition will improve or stabilize so they are no longer medically eligible for hospice services, or they may live past the six-month life expectancy, but still have a terminal diagnosis. These occasions can then require:
- Extension – If a patient lives longer than six months, they can receive an extension and continue hospice care, provided the hospice medical director recertifies their hospice status.
- Discharge – If a patient improves or stabilizes and is no longer medically eligible, he/she can be “discharged” from hospice care and revert back to Medicare benefits and other coverage they had before electing hospice care.
- Revocation – If a patient decides to once again seek disease-curative therapies, such as a clinical study for a medicine or a procedure, he/she can file for a “revocation” and withdraw from hospice care.
- Re-enrollment – If patients choose to be removed or are discharged from hospice care, they can re-enroll without penalty when they once again meet the medical criteria.
When determining if hospice is the right decision, consider some of the diagnostic questions:
- Has your loved one been diagnosed with a terminal illness or given a limited life expectancy by a doctor?
- Do they need help eating, walking, sleeping, bathing, or getting in/out of bed?
- Have they fallen several times in the past six months?
- Have they gone to the emergency room or hospital several times in the last six months?
- Have they lost certain functions (like bladder or bowel) or had recurring infections?
For the full list of questions, review the Heart to Heart Hospice survey here: Is it Time for Hospice?