Patients must meet the hospice eligibility requirements specified by the US Centers for Medicare & Medicaid Services to begin hospice care. While there is no requirement for a certain number of symptoms to qualify for hospice, these recommendations can help decide if a patient’s condition is, or will soon be, suitable for hospice care.
Hospice qualifying requirements are as follows:
- Patient has been diagnosed with a life-limiting condition with a prognosis of six months or less if their disease takes its course
- Frequent hospitalizations in the last six months (taking into consideration edema weight)
- Deteriorating mental abilities
- Recurrent infections
- Skin breakdown
- Specific decline in condition
- Increasing weakness, fatigue, and somnolence
- A change in cognitive and functional abilities
- Compromised Activities of Daily Living (ADLs) such as eating, bathing, dressing, toileting, transferring/walking, and continence
Criteria for hospice eligibility based on a certain disease.
Based on the patient’s primary diagnosis, there are additional unique hospice qualifying criteria to consider. By selecting a disease from the list below, you will be able to read about the hospice care standards that apply to that disease.
- AIDS
- Cancer
- Cerebral Vascular Accident (CVA) / Stroke
- COPD / Cardiopulmonary Disease
- Dementia
- Liver Disease
- Neurological Conditions (non-dementia, Alzheimer’s Parkinson’s disease, Multiple Sclerosis, ALS, and Huntington’s disease)
- Renal Disease
Hospice has the following financial requirements:
- Medicaid hospice eligibility criteria
- Medicare qualifying criteria for hospice care
- Hospice eligibility criteria for private insurance
Please keep in mind that co-morbidness, or the existence of two or more chronic diseases or disorders at the same time, are also considered when determining whether or not you qualify for hospice.
Get in touch with Oasis Hospice today at (708) 564-4838 so that we can help you get started on the process to help you and your loved ones.