How Do You Become Eligible For Hospice?

Looking for hospice care for your loved one can be stressful enough; add to that the headache of trying to determine if they are eligible for hospice, and this can be a daunting and confusing time. Thankfully, there are resources available so you don’t have to face that decision alone. You may, understandably, be concerned about how you will pay for hospice care. There are many options to that end, including private insurance, Medicare, Medicaid, HMOs, and other managed care organizations. There are certain requirements that have to be met in order to receive benefits from Medicare, and be eligible for services. Together with your loved one’s doctor and hospice care professional, you can explore whether your loved one is eligible for hospice.

It’s important to note, however, that eligibility and payment are two separate things. First it must be determined if your loved one can enter hospice care based on the state of their health. Then, it will be determined how that hospice care will be paid for.

Who Makes the Determination

Only the hospice doctor and the primary care doctor can certify that someone is terminally ill with a life expectancy of six months or less, says Medicare. A nurse practitioner, by contrast, cannot certify that someone is terminally ill. There is no age restriction when it comes to who qualifies for hospice: anyone in the last stages of life can qualify. Other considerations that must be met include:

  • The patient and family must be able to fully understand the prognosis and agree to seek palliative (also known as comfort) care instead of seeking a cure.
  • Patient and family must provide informed consent.
  • Patient and family must choose the hospice benefit by completing and signing an election form, according to

As part of determining eligibility, the doctors must first evaluate the patient for pain and symptom management, counsel the patient on hospice and any other options available to him or her, and advise the patient on advanced care planning. The patient must be determined to have a terminal illness with a prognosis of less than six months to live. It’s important to note, however, that a person who shows marked improvement throughout hospice may exit hospice at any time. Likewise, any patient who decides to re-visit the possibility of curative measures can do so at any time.

A Team of Support

If and when your loved one qualifies for hospice care, the family can work alongside the hospice team to develop a plan of care. Other members of the team could include the following:

  • Doctors
  • Nurses
  • Counselors
  • Social workers
  • Physical and occupational therapists
  • Speech-language pathologists
  • Hospice aides
  • Pharmacists
  • Chaplains

A disease doesn’t have to be terminal due to cancer for someone to qualify for palliative care, with many treatments covered by Medicare, according to Help Guide. Palliative care helps alleviates symptoms, with a focus on the relief of pain, symptoms, and emotional stress as a result of a serious or terminal illness. Serious illnesses can include liver disease, heart disease, Parkinson’s and dementia. Palliative care typically comes before hospice care, offering a multi-disciplinary approach to treating serious illness. Like hospice, the focus is on comfort rather than on a cure. When a transition from palliative care to hospice is necessary, a doctor is then called on to make a recommendation. If your loved one qualifies, hospice offers additional services with fewer restrictions than palliative care.

Of course, it’s difficult if not impossible for any doctor to say with certainty that a particular patient will die within six months. For patients with a longer than expected survival, reevaluation at time of re-certification will show that the patient is still eligible for home hospice care, according to the Stanford School of Medicine. If there is an unanticipated recovery, which is rare, they may be discharged from hospice but readmitted later.

Learn More with Pathways Home Health Hospice

To learn more about hospice and eligibility, get in touch with us here at Pathways Home Health Hospice at 888-755-7855. We are a home health care and hospice agency dedicated to giving you and your loved ones comprehensive care when it matters most.