What Are the Criteria for Hospice Care?

Hospice care focuses on patients’ needs when they are close to their end of life. A prime example is individuals with end-stage Parkinson’s Disease.

How to know if the patient is in the end stage of Parkinson’s Disease? The symptoms that show the medications and therapy don’t work anymore are the loss of balance and coordination in the body, poor speech, loss of smell, and inability to stand or walk alone. At this period, the patient may need to use a wheelchair, become bedridden, and experience depression.

If the patient reaches the end stage of Parkinson’s Disease, they will need help from family or nurses at all times. They will require proper care, physically, mentally, and spiritually.

When To Get Hospice Care

When the patient continues to be weak, is hospitalized more often, and can no longer move alone, hospice care comes into the picture. It’s also an option when there is no one else to care for their patients anymore due to work or personal reasons such as stress and fatigue.

How Do You Qualify for Hospice Care?

Before discussing the qualifications for hospice care, remember that each hospice provides primary care but is different from the other. Although most patients use Medicare, Medicaid, or additional insurance to pay their hospice bills, there are hospice care costs that are not covered.

There are two main hospice criteria for getting hospice care associated with granting consent.

Patient and Family Consent

The patient’s family should be aware that getting hospice care is choosing to focus on supporting and giving comfort to the patient than treatment to cure their illness or disease.

If the patient health improves and shows signs and recovery, they will be discharged and restart medical treatment.

Doctor’s Diagnosis and Referral

The referral of the patient’s doctor must guarantee that the patient has a terminal illness with a life expectancy of fewer than six months. These life-limiting conditions are cancer, end-stage Parkinson’s Disease and Alzheimer’s, AIDS, stroke, and heart and lung diseases.

The Requirements for Hospice Care for Each Disease

If the patient was diagnosed with a life-limiting illness and only has a few months to live, they can already avail of hospice care. But, there are different hospice diagnosis criteria for each type of disease.

Here are the criteria to consider based on the patient’s diagnosis:

Neurological Hospice Eligibility Criteria

Patients with neurological conditions like MS, ALS, Huntington’s, and end-stage Parkinson’s disease are eligible for hospice care. The hospice diagnosis criteria for these conditions are difficulty doing daily living activities and cognitive and sensory impairment. The incapacity to move on their own and impaired verbal communication is also a sign of the final stages of their illness.

Hospice Cancer Criteria

If the patient’s condition didn’t improve despite continuous treatment or the PPS goes 70%, and below, they are eligible for hospice care. Patients with metastatic cancer who choose not to undergo curative treatment other than chemotherapy are also eligible. Patients with pancreatic, CNS malignancies, and small cell lung cancer are eligible for hospice care without the other hospice cancer criteria.

CHF and Heart Hospice Eligibility Criteria

Sudden weight loss, chest pain, shortness of breath, irregular heartbeat, and insomnia are some of the requirements for hospice care for patients with heart conditions. An ejection fraction less than 20% is not required but may be needed by the hospice to be eligible. If you see these symptoms with impaired blood supply and the patient is unresponsive to diuretics and vasodilators, it may be the time to call for hospice care.

Hospice Qualifications Dementia

Dementia is a disease that can progress rapidly or slowly, making it difficult to determine a patient’s eligibility for hospice care. Other than the six-month life expectancy and weak state, to meet the hospice criteria for dementia patients, they have to be experiencing drastic weight loss due to difficulty in eating and drinking.

The dementia patient is also eligible for hospice care if diagnosed with COPD, CHF, pneumonia, and sepsis. Once the patient starts to speak less than six words a day, no longer smiles, experiences urinary issues, and cannot move alone, they have reached the final stage of dementia and may require hospice care.

AIDS Hospice Care Requirements

Since AIDS still has no cure, patients with a CD4 count of less than 25, viral load of over 100,000 copies/ml, drastic weight loss, and chronic diarrhea are eligible for hospice care. Another criteria to consider is when the patient got 50% or less PPS and was diagnosed with other illnesses such as Toxoplasmosis. Additionally, patients who abuse substances are advised for hospice care.

Other Criteria for Hospice Care

While there is no set number of symptoms required to qualify, here is a list of other qualifications to be eligible for hospice care: