Skip to Main Content
Google Plus Logo
Home Nursing Services
At Home Therapies
Home Care FAQ
Bereavement & Grief
Hospice & Alzheimers
Hospice Pet Therapy
Special Care Programs
Your Care Team
Specialized Home Care
Patient-Centered Dementia Care
Congestive Heart Failure
Hypertension / Blood Pressure
Coronary Artery Disease
Mental Health and Depression
Home Care Support for Multiple Sclerosis
Paraplegia and Quadriplegia
Traumatic Brain Injury
Our Standard of Care
Caring Brands International
Aging in Place
Questions to Ask Before Hiring a Home Health Aide
8 Dietary Tips for Improving Senior Heart Health
Talking About Substance Abuse as a Caregiver
How to Take Care of Aging Hair
4 Ways to Improve Indoor Air Quality for Seniors
Designing Outdoor Living Areas for Seniors
Getting A Grip: How and Where to Install Bathroom Grab Bars
Keeping Active: Tips for Senior Gardening
Alzheimer's and Dementia
Calculating the Cost
Certified Senior Advisors
Consumer Health Care Education
Advisor Care Giving Guide
Care in a Residential Facility
Check Your Home Care IQ
Elder Care Communities
Medicare and Home Care
Senior Care Resources
Senior Care Scams
Signs That Care At Home is Needed
Long Term Care
Mobility in Seniors
Home Safety Checklist
Home Safety Tips
Medications and Fall Risk
Reduce the Risk of Falling
Risk of Falling
Visiting the Doctor and Discussing Falls
What to Do If Someone Falls
Elder Care Videos
Hiring Your Own Caregivers
Family Care Giving Facts
Information for Seniors
Long Distance Caregiving
Starting the Conversation
The Stress of Family Caregiving
Taking Care Of Yourself as a Family Caregiver
Home Care Technology
Hospice Fact or Myth
Exercise and Older Adults
Tips for Lowering Blood Pressure
Seniors and Zika Virus
Stories From Home
Transitioning from a Facility
Independent Living Assessment
Where are you looking for Care?
How do patients qualify for hospice care?
How do patients qualify for hospice care?
Posted: 6/5/2019 8:00 AM by
Hospice provides an incredibly important role for the terminally ill and their families. It provides access to 24/7 comfort care, education and emotional support. Hospice staff helps families solve the countless practical challenges that emerge during the end-of-life journey.
During an incredibly difficult time, hospice care provides important care, information and peace of mind for patients and their families. In fact, many families share that they wish they had summoned hospice care sooner.
Why People Wait Too Long to Choose Hospice
When do patients qualify for hospice care?
When determining eligibility for hospice, a doctor must certify that the patient is terminally ill, with a life expectancy of six months or less if the disease runs its expected course. The hospice medical director must agree with the doctor’s assessment.
This is the primary criteria used for determining hospice eligibility for patients.
There are three (3) primary situations that precede a doctor recommending hospice care:
1. Lack of improvement.
Despite treatment, the patient’s condition isn’t improving. The person isn’t feeling better and the illness has progressed to end-stage disease.
2. Goals of care have changed.
For instance, often a patient realizes they are not getting better and doesn’t want to be in a hospital or go to a hospital anymore. Someone who’s becoming more and more anxious about the prospect of dying might also be referred for hospice care.
3. Acute health events.
Patients who suffer from an acute event, like a heart attack or stroke, may require end-of-life care.
Once a doctor has referred the patient to hospice, a hospice nurse will visit and conduct a health assessment. Some common signs among patients who qualify for hospice include:
Weight loss of 10 percent within the previous three to six months
Insufficient hydration and nutrition or decreased ability to benefit from nutritional support
Increasing shortness of breath
Inability to perform most daily activities independently; spends most of the time in bed or a chair
Increased fatigue and daytime sleeping
Progressively worse incontinence
Recurrent or multiple infections
Increased cognitive impairment, confusion, unintelligible speech
Increased visits to the hospital or ER, with limited improvement
Rapid disease progression despite treatment
Pain or emotional suffering
After this assessment, acceptance into hospice is “a team decision,” says Interim HealthCare National Director of Hospice Services Tammy Fox, RN, “but ultimately, eligibility rests with the hospice medical director.”
Once a person is deemed eligible for hospice, the patient must elect to receive it in place of curative care.
How are costs covered for hospice care?
Hospice is covered under the Medicare Hospice Benefit for patients who are covered by Medicare and eligible for Medicare Part A—Hospital Insurance. Income-eligible Medicaid patients also receive a hospice benefit.
Most private insurance companies provide some degree of hospice coverage as well. The Veteran’s Health Administration provides hospice coverage similar to Medicare for eligible United States veterans.
Approval of services from a doctor and hospice team are critical for any of these benefits to be paid for hospice care. Without them, most costs associated with hospice care will require out-of-pocket payment.
What if a person lives beyond six months while in hospice care?
Medicare patients are entitled to an unlimited number of 60-day benefit periods after the initial six months, if they are recertified as terminally ill with a prognosis of six months or less. The process of meeting with and being evaluated by the hospice care team will need to be repeated.
According to the Medicare Rights Center, meetings to reapply for hospice care should take place before the end of the current benefit period but no sooner than 30 days before the next period. If hospice care is being provided by private insurance, make sure you understand your insurance company’s policies about continuing coverage.
Providing support and dignity to patients and their families.
is never easy, but here at
we work together with patients, their families and hospitals to provide exceptional care and support. To speak with a compassionate Interim HealthCare representative in your community, use the locator below to find your local Interim HealthCare location.
Find a Location Near You or Call
Select a distance in miles