Hospice Eligibility
Overview
Advocate Hospice strives to provide excellent hospice and palliative care to eligible patients who benefit
tremendously from hospice services. As such, we follow Medicare's Hospice Eligibility Guidelines to ensure
that we provide the best outcome for patients, whether they come into our service or not.
If you would like to determine if you or someone you know may qualify for hospice, Advocate Hospice has
created the Eligibility Assessment: a short questionnaire (11 questions, for approximately 2-5 minutes) designed
to indicate common qualifications for hospice eligibility. Additionally, we have provided detailed information below which
outlines some of the common qualifications for hospice eligibility.
To be eligible for hospice, the patient must have a life expectancy of six (6) months or less to live. Commonly,
if a patient has been diagnosed with a chronic condition or is suffering from a disease that does not respond to
treatment, then there is ground for a hospice evaluation by a medical doctor. There are many health conditions which may result in admission
to hospice due to factors unique to each patient. As such, the following sections provide some of the most prevalent health conditions which
may result in hospice care.
Common Diagnoses for Hospice Eligibility
Cancer Diagnoses
A cancer patient may have a life expectancy of six (6) months or less if they have distant metastases at presentation or progression from an earlier stage of disease to metastatic disease with either:
- a continued decline in spite of therapy
- the patient declining further disease directed therapy
What this means is that when cancer spread can no longer be controlled or when a patient no longer desires treatment,
then hospice may be appropriate. Whether or not the patient comes onto hospice is up to them, or alternatively the PoA (Power of Attorney) if the patient is unable to consent.
Note: Certain cancers with poor prognoses (e.g. small cell lung cancer, brain cancer, and pancreatic cancer)
may be hospice eligible without fulfilling the other criteria in this section.
Non-Cancer Diagnoses
The following section provides a list of common diseases/illnesses that may result in hospice eligibility:
- Amyotrophic Lateral Sclerosis
- Dementia due to Alzheimer's Disease and Related Disorders
- Heart Disease
- HIV Disease
- Liver Disease
- Pulmonary Disease
- Renal Disease (Acute renal failure or Chronic renal failure)
- Stroke & Coma
- Other
- the hospice Medical Team must provide information that supports a terminal illness with a prognosis of six (6) months or less
Eligibility Assessment
To find out whether you or someone you know may qualify for hospice, answer the following eligibility assessment.