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Eligibility

Hospice programs serve patients of any age. In order to be eligible for hospice care:

  • The physician must certify that the patient has less than six months to live if the disease runs its normal course. The physician completes a form, which is called a Certification of Terminal Illness or a Doctor's Order for Hospice. It is important to note that the patient may receive hospice care for more than six months if the physician certifies that the patient remains eligible.
  • A nurse or physician from the hospice program must evaluate the patient and concur with the referring physician that the patient is eligible for hospice.
  • The patient must sign a statement that he or she understands the nature of his illness as well as the nature of hospice care (palliative or “comfort care” rather than curative treatment). If the patient is unable to understand, then the family or designated person may sign on his or her behalf.

Hospice patients are re-evaluated on a regular basis by hospice staff to ensure that they continue to meet the eligibility criteria. If the patient no longer meets the criteria (generally due to improvement in medical condition or ability to function), the patient is discharged and referred to appropriate medical care.

Image of a profile of an elderly woman.To be eligible for hospice coverage under Medicare, a patient must be enrolled in a Medicare-certified hospice. If the patient is covered by other insurance, the hospice program must participate in the insurance plan in order for hospice care to be covered.

Although many people believe that hospice care is only for cancer patients, hospice programs serve patients with many different diagnoses. According to the National Association for Home Care, in 1998, 57 percent of hospice patients had a primary diagnosis of cancer. Other diagnoses included congestive heart failure, chronic obstructive pulmonary disease, stroke, and Alzheimer's disease.