What qualifies a patient for hospice care?

Hospice Eligibility Criteria

Patients qualify for hospice care when they have a terminal prognosis of less than 6 months as certified by a treating physician and hospice medical director, and they agree to forego curative treatments for their terminal illness in favor of comfort-focused care. 1

General Eligibility Requirements

Hospice care is designed for patients at the end of life who meet specific criteria:

1. Terminal prognosis of less than 6 months, certified by two physicians
2. Patient's written agreement to focus on comfort rather than curative treatment
3. Primary goal of maximizing comfort and quality of remaining life 1

Disease-Specific Eligibility Criteria

Advanced Lung Disease

Patients with advanced pulmonary disease qualify for hospice if they meet:

1. Required criteria (both must be present):

   • Severe chronic lung disease with:
     • Disabling dyspnea at rest, poorly responsive to bronchodilators
     • Decreased functional capacity (bed-to-chair existence)
     • Disease progression evidenced by increasing ED visits/hospitalizations
   • Hypoxemia at rest (PO₂ ≤55 mmHg or O₂ saturation ≤88%) or hypercapnia (PCO₂ >50 mmHg) 2

2. Supporting criteria (strengthen the case):

   • Right heart failure secondary to pulmonary disease
   • Unintentional weight loss >10% over 6 months
   • Resting tachycardia >100/minute 2

Other Non-Cancer Conditions

Eligibility criteria vary by condition:

• Heart Failure: NYHA Class IV symptoms despite optimal treatment, ejection fraction <20%, multiple hospitalizations
• Advanced Cirrhosis: Complications, ineligibility for transplant, hepatorenal syndrome, progressive malnutrition
• Neurodegenerative Conditions: Progressive decline with complications 1

The "Surprise Question" Assessment Tool

A valuable screening tool for clinicians is the "surprise question": "Would you be surprised if the patient dies within the next six months?" If the answer is "no," this should trigger hospice evaluation. 1

Common Pitfalls in Hospice Referrals

1. Delayed referrals: The average length of hospice enrollment before death is only 2 months, with almost 30% of patients entering hospice in their final week of life. This significantly limits the benefits patients and families receive. 2

2. Misconceptions about hospice: Many incorrectly believe hospice is only for the last hours to days of life, or that symptom management at end of life hastens death. In fact, studies show hospice patients with lung cancer lived an average of 29 days longer than similar patients not referred to hospice. 2

3. Prognostic uncertainty: Traditional clinical prediction criteria for non-cancer diagnoses often fail to accurately identify patients with a 6-month prognosis. This is particularly challenging for conditions like COPD, heart failure, and liver disease, leading to underutilization of hospice for these patients. 3

4. Confusion between palliative care and hospice: Palliative care can be provided alongside curative treatments without requiring a terminal diagnosis, while hospice requires the terminal prognosis and foregoing curative treatment. 1

Medicare Hospice Benefit Requirements

Under Medicare, patients must:

• Have Medicare Part A
• Be certified as terminally ill with a life expectancy of 6 months or less
• Sign a statement choosing hospice care instead of standard Medicare benefits for their terminal illness
• Receive care from a Medicare-approved hospice program 1

Benefits of Timely Hospice Referral

Early referral to hospice provides:

• Improved symptom management
• Enhanced quality of life
• Support for patients and families in grief preparation
• Comprehensive interdisciplinary care including medical, social, and spiritual support
• Potential for longer survival compared to standard care 2, 1

Remember that hospice is not about giving up hope, but rather redirecting hope toward comfort, dignity, and quality of life when curative options are no longer effective or desired.