Hospice & Palliative Care Eligibility Guide

The following circumstances qualify a patient for hospice or palliative care:

• Compromised ability to complete daily living activities
• Diagnosis of a life-limiting condition with a prognosis of six months or less
• Frequent hospitalizations in the past six months
• Progressive weight loss
• Increasing weakness, fatigue and somnolence
• A change in cognitive and functional abilities
• Deteriorating mental abilities
• Recurrent infections
• Skin breakdown
• A specific decline in condition
• Palliative eligibility criteria
• Declining ability to complete daily living activities
• Life-limiting illness or terminal diagnosis
• Multiple hospitalizations and emergency room visits
• Serious disease progression
• Complex symptom management
• Need to develop goals of care
• Advance care planning needs

General In-patient criteria include:

• Sudden deterioration requiring intensive interventions
• Uncontrolled nausea or vomiting despite changes to medications
• Pain despite numerous changes to medication
• Unmanageable respiratory distress
• Complex wound/skin care requiring complex destressing changes
• Change in neurological status: New/worsening agitation, delirium, restlessness, acute and/or a new change in LOC, active seizures
• Terminal agitation, needing frequent interventions and/or unresponsive to medications
• Frequent interventions for comfort during the dying process

A patient may also be eligible for inpatient care if they have any of the following unmanaged symptoms:

• Pain
• Dyspnea
• Secretions
• Anxiety
• Constipation
• Agitation
• Nausea/Vomiting
• Diarrhea
• Wounds
• Seizures
• Hemorrhage

Although not the primary hospice diagnosis, the presence of the following diseases (the severity of which is likely to contribute to a life expectancy of six months or less) should be considered in determining hospice eligibility:

• AIDS
• Cancer
• Cerebral Vascular Accident (CVA) / Stroke
• Congestive Heart Failure / Cardiopulmonary Disease
• COPD / Cardiopulmonary Disease
• Dementia
• Liver Disease
• Neurological Conditions (non-Alzheimer’s dementia, Parkinson’s disease, Multiple Sclerosis, ALS, and Huntington’s disease)
• Renal Disease