Paying for hospice & eligibility

Admission Guidelines

General guidelines for admission for hospice services include:

  • A person with a serious illness whose prognosis may be six months or less, if the disease runs its normal course, as determined by the medical judgment of the person’s primary physician.

  • A person who, along with his/her physician, desires palliative care intended to relieve suffering and the distressing symptoms accompanying the disease process.

  • A primary physician consents to hospice care for him/her. If the patient has no attending physician, the medical director may serve as the physician.

  • Patient and/or family agree not to treat terminal illness aggressively.

Criteria for Admission and Guidelines for Determining Prognosis

Generations Hospice care determines appropriateness for hospice care for cancer and non-cancer diagnoses by using Medicare guidelines. Non-cancer diagnoses include End Stage Dementia, End Stage Renal Disease, End Stage Cardiac Disease, End Stage Pulmonary Disease, End Stage Liver Disease, HIV Disease, Stroke and Coma, Failure to thrive and Amyotrophic Lateral Sclerosis.

In addition to meeting other disease specific criteria, Hospice patients may also exhibit the following in the past two to three months:

  • Decline/Decrease in Activities of Daily Living (ADL).

  • Weight loss or decreased appetite.

  • Decline/decrease in cognitive abilities.

  • Observable changes in condition.

  • Lack of response to treatment and worsening of symptoms of a chronic underlying disease.

Hospice Eligibility

Hospice care is covered under Medicare Part A (Hospital Insurance). You are eligible for Medicare hospice benefits when you meet the following conditions:

  • You are eligible for Medicare Part A, and

  • Your doctor and the hospice medical director certify that you are terminally ill with a prognosis of six months of less, if the disease runs its normal course, and

  • You sign a Benefit Election form choosing hospice care instead of routine Medicare covered benefits. (Medicare will still pay for covered benefits for any health problems that aren't related to your terminal illness).

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