Hospice & Palliative Care Eligibility Guide
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- 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