Providing excellence in end-of-life care.

Who is eligible for hospice care?

A common misconception about hospice is that it is a service provided only to cancer patients. The fact is that we provide care to patients with any end stage diagnosis. These may include, but are not limited to:

Is it true that you must have only six months to live to be eligible for the Medicare Hospice Benefit?

Another common, and unfortunate, misconception about hospice is that the use of hospice care somehow guarantees the patient has less than six months to live. Medicare defines the hospice standards that are used by Medicare hospice providers, Texas hospice providers and most private insurance companies. Medicare has provided the following explanation and clarification regarding the hospice benefit eligibility guidelines.

"Generally speaking, the hospice benefit is intended primarily for use by patients whose prognosis is terminal, with six months or less life expectancy. [However], the Medicare program recognizes that terminal illnesses do not have entirely predictable courses."

" Recognizing that prognoses can be unpredictable and may change, Medicare's benefit is not limited in terms of time. Hospice care is available as long as the patient 's prognosis meets the law's six month test. This test is a general one - based on the [attending] physician's and/or Medical Director 's clinical judgment regarding the normal course of the individual's illness. Medicare recognizes that making medical prognostications of life expectancy is not always an exact science."

Under this philosophy, Medicare has specified a procedure for certification and periodic recertification of the patient's eligibility for care under the Medicare Hospice Benefit. This procedure provides two 90-day eligibility certification periods followed by an UNLIMITED number of 60-day eligibility certification periods. As long as the patient, in the judgment of the primary physician and hospice Medical Director, continues to meet the six month criteria during each certification period, the patient can continue to receive care under the Medicare Hospice Benefit.

When does hospice care become appropriate?

Hospice care becomes appropriate when an individual has a life-limiting illness or condition. The following guidelines are used to assist the physician and hospice Medical Director in making a judgment regarding an individual's eligibility for hospice care.

The patient has a declining functional status as determined by either:

A Karnofsky Performance Status of 50% or less.
(The Karnofsky Performance Status is an evaluation that assesses a person's ability to function independently.)
Dependence in 3 out of 6 Activities of Daily Living
Frequent hospitalizations
Frequent trips to the Emergency Room
Weight loss of 10% or more in the last 4 to 6 months
Serum Albumin less than 2.5 gm / dl.
(Albumin is a component of protein and makes up one half of plasma protein.)
Patient and family have elected palliative care rather than curative treatment

We have also prepared the following brief questionnaire that can help you determine whether hospice care is right for you or your loved one.

Informal Hospice Eligibility Questionnaire

I have started feeling more tired and weak.
I experience shortness of breath, even when resting.
I spend most of the day in a chair or in bed.
I make frequent phone calls to my physician.
I take medications to lessen physical pain.
I have fallen several times in the past six months.
I have made frequent trips to the emergency room in the past six months.
I need help from others with important daily activites (bathing, dressing, eating, cooking, walking, getting out of bed).
My doctor has told me my life expectany is limited.

If you have checked 4 or more items on the questionnaire, you may want to begin your research into hospice care by seeking the opinion and advice of your (or the affected individual's) primary physician.