To be eligible for the Medicare Hospice Benefit, two physicians (generally a referring physician and a hospice medical director) must certify that in their judgment the patient is expected to live less than six months if their illness runs its normal course. Prognosticating is not always easy, and many professionals struggle to determine the hospice eligibility for their patients. We often see eligible patients referred to Seasons with only days or hours left to live, limiting the full usefulness of the holistic care the hospice interdisciplinary team can provide to them and their families.

Eligibility by Diagnosis

The following videos explain the general indicators for hospice eligibility for a variety of illnesses. We also have printed materials available that can help assist with determining hospice eligibility. If you would like one of our hospice care consultants to bring you materials, or if you would like our medical director or one of our team physicians to discuss prognostic indicators, please contact us and we will be happy to support you however we can.

Alzheimer’s Type Dementia

Alzheimer’s can be one of the more difficult diseases to prognosticate hospice eligibility. This video goes over some of the major factors to consider for a primary diagnosis of Alzheimer’s Type Dementia.

 

ALS

ALS patients tend to decline at a consistent rate, but that rate is different for each patient. This overview highlights some of the clinical parameters a physician needs to know when referring to hospice.

Cancer

The hospice movement originally started in the United States to serve patients primarily facing cancer diagnoses. This video outlines the hospice eligibility for cancer patients.

Heart Failure

At Seasons, we see many patients with heart disease diagnoses be referred very late in their trajectory. Seasons follows the ACC / AHA HFSA guidelines for end of life heart failure patients to support them through their journey.

 

Advanced HIV/AIDS

To be eligible for hospice, an Advanced HIV/AIDS patient must display multiple conditions, including a PPS ≤ 50% and other factors.

Liver Disease

Liver disease has multiple requirements for hospice eligibility. This video discusses the ‘must’s’ and supporting factors for hospice eligibility.

Pulmonary Disease

To be eligible for hospice a pulmonary patient must have disabling dyspnea, documented progression of ESPD, and hypoxemia or hypercapnia.

Acute Renal Failure

To be eligible for hospice, acute renal failure patients must no longer be seeking dialysis or renal transplant. They must also present one of several factors.

Chronic Renal Failure

To be eligible for hospice, chronic renal failure patients must no longer be seeking dialysis or renal transplant, and must present one of three factors.