Hospice Care Eligibility

Hospice care is end-of-life care: treatment that serves the needs of the terminally ill. The emphasis of hospice care is palliative rather than curative, meaning that it focuses on pain relief and keeping the patient comfortable. End-of-life services also address a person’s psychological and spiritual well-being. Hospice care doesn’t happen automatically; certain criteria must be met before a patient becomes eligible.

Baptist Health is dedicated to providing support and care for persons with a terminal condition. Through a dedicated team approach, our hospice service provides physical, emotional, and spiritual assistance to those with life-limiting illnesses, by focusing on quality of life. 

What Criteria Determines Hospice Care Eligibility?

Eligibility for hospice care depends on meeting the requirements of the U.S. Centers for Medicare & Medicaid Services (CMS). Among these requirements are:

  • The patient has been diagnosed with a terminal illness that, under usual circumstances, will run its course in six months’ time or less.
  • Frequent hospitalizations in the recent past.
  • Growing incapacity to manage activities of daily living, such as walking, eating, dressing, bathing, and using the toilet. 
  • Medical symptoms including some or all of the following: weight loss, extreme fatigue or torpor, declining cognitive and functional abilities, unremitting infections, and signs of terminal aging, such as skin breakdown. 

There are no age requirements for hospice care but there are disease-specific criteria that must be met. These have been established for a broad array of medical conditions, including cancer, stroke, cardiopulmonary diseases, AIDS, dementia, kidney disease, liver disease, and neurological disorders. Co-morbidities, or the presence of two or more medical conditions in one patient, increase the likelihood of hospice eligibility.

Finally, there are financial requirements for hospice care. Private insurance typically covers hospice care, though sometimes with policy-defined qualifications. Medicare coverage depends on Part A enrollment. Medicaid coverage may be available for some individuals, in addition to Medicare. All types of coverage require that the patient be diagnosed with six months or fewer to live, and that curative treatments be replaced by palliative ones.

Who Determines If I Will Receive Hospice Care?

The following individuals or parties are responsible for the decision to receive hospice care, based on meeting the eligibility criteria described above:

  • Both the patient’s primary care physician and his or her medical counterpart at the hospice provider must certify that the patient in question is terminally ill with a life expectancy of no more than six months.
  • Both the patient and the patient’s family must provide informed consent to end curative care and to initiate hospice services. 
  • The patient and his or her family must fill out and sign a hospice-election form, as provided by the U.S. Centers for Medicare & Medicaid Services. 

Additional information on hospice benefits and eligibility is available from the U.S. Centers for Medicare & Medicaid Services

Learn More About Hospice Care Eligibility from Baptist Health

End-of-life care is as important as any other care a person ever receives – maybe more so. If you believe a loved one may be eligible for hospice care, please contact Baptist Health Hospice Services at 270.326.4660.