Hospice & Palliative Care Eligibility Guide

What you need to know to refer patients and families!

This eligibility guide will help you recognize when a patient would benefit from hospice, palliative or inpatient hospice care.

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

We are here to Help!

Pathways is proud to partner with you to provide the highest quality care for your patients. Referrals can be made 24/7.

Phone: 970-292-2388
Fax: 970-663-1180
Email: providerrelations@pathways-care.org