Hospice and Palliative Care Eligibility Guidelines

Hospice and palliative care are both intended to improve a patient’s quality of life by helping them manage pain and symptoms. But despite that common goal, there are still differences between them, including guidelines for eligibility. 

Eligibility Guidelines for Hospice Care 

Hospice care is intended for patients with a life-limiting illness who are no longer pursuing curative treatments and have a prognosis of six months or less. 

A hospice beneficiary must be certified as terminally ill and the physician making the determination to certify as terminally ill must consider the following: primary diagnosis of the terminal condition; secondary diagnoses related to the primary terminal condition; co-morbidities; current clinically relevant information supporting the certification.

Signs and symptoms that your patient may need hospice include:

  • Uncontrolled or increasing pain
  • Increased shortness of breath 
  • Increased dysphagia
  • Progressive, uncontrolled swelling 
  • Unresolved nausea/vomiting 
  • Oxygen dependence 
  • Progressive weight loss 
  • Mounting kidney and urinary difficulties 
  • Frequent infections 
  • Numerous hospitalizations and ER visits 
  • Profound weakness and fatigue 
  • Worsening mobility and function

For more information on condition-specific guidelines, please see this referral guide.

Palliative Care Eligibility 

Palliative care treats people suffering from serious and chronic illnesses such as cancer, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), kidney failure, Alzheimer’s, Parkinson’s, amyotrophic lateral sclerosis, (ALS) and many more. Palliative care focuses on symptoms such as pain, shortness of breath, fatigue, constipation, nausea, loss of appetite, difficulty sleeping, and depression.

To learn more about our hospice and palliative care, or to refer a patient, please contact us today.