General Hospice Eligibility Criteria for Admission

General Hospice Eligibility Criteria for Admission

Who is Eligible for Hospice?

When is the right time for you, your loved one, or your patient?

Serious illness can be overwhelming for patients, families, and friends. There are so many critical decisions at each step of the way!

What treatment path should we follow?

Who will guide us on how effective that choice may be – and at what cost of side effects and quality of life?

How do we know when’s the right time to consider the extra layer of support that hospice can provide when an illness continues to advance despite the most aggressive treatments?

The following overview on hospice eligibility criteria can help – and our nurses are always available to answer your personal questions to help make your transitions less stressful.

Have Questions about Your Patient’s or Loved One’s Hospice Eligibility?

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Eligibility by Disease: Hospice | Cancer | Heart Disease | Dementia | For Healthcare Professionals 
Referral Form | Additional Resources | Inpatient Hospice Criteria 

What are the Criteria for Hospice Care?

Picture of an old lady taking a walk with her granddaughterThe comforting care of Samaritan Healthcare & Hospice is open to people of all age groups, including children, who live within Atlantic, Burlington, Camden, Gloucester, or Mercer counties. People seeking care for themselves or someone they care for should meet the following hospice eligibility criteria:

♦ The patient has a serious and progressive illness of any diagnosis.*

♦ The patient chooses to pursue care focused on comfort rather than treatment focused on cure.

♦ The patient needs help with a minimum of 3 of the so-called Activities of Daily Living (ADLs). ADLs are the 6 basic tasks of everyday life that healthy people can usually do without help. These activities include: eating, bathing, dressing, toileting, walking or transferring from place to place, and continence (control of bladder and bowels).

♦ The patient’s primary care physician (family doctor or specialist) would be surprised if he/she lived beyond 6 months.

♦ The patient is no longer receiving aggressive medical treatment to cure his/her disease or to postpone death through unnatural means. Some examples of aggressive treatment include chemotherapy, surgery, and dialysis.

♦ The patient has received a prognosis of six months or less to live. A prognosis is a forecast of the likely outcome of an illness or injury. It is based on a doctor’s best judgment if the disease follows its normal course. Since no doctor can predict what is going to happen with 100% certainty, many hospice patients outlive their doctors’ expectations.

♦ The patient’s personal physician and Samaritan’s Medical Director both review the medical records and agree that the prognosis meets hospice eligibility criteria.

♦ The patient and family/caregivers understand, agree with, and accept the Hospice concept and method of care that will be explained to them before they enroll.

♦ Patients eligible for Medicare benefits must be covered by Medicare Part A.

In addition to the above criteria, many hospice-eligible patients have had frequent hospitalizations and/or emergency room visits over the last 6 months related to their serious illness.

Six Months or Less to Live

A person of any age is eligible for hospice after being certified by a physician as having a life expectancy that may be six months of less, depending on the course of the disease.

General Signs & Symptoms

  • Increased or uncontrolled pain
  • Progressive weight loss
  • Swallowing difficulties
  • Shortness of breath
  • Nausea/vomiting that does not respond well to medications
  • Increased edema or ascites
  • Decline in ability to perform activities of daily living
  • Frequent infections
  • Frequent hospitalizations or ER visits
  • Increased weakness and/or fatigue
  • Increased skin problems
  • Withdrawal, confusion, bedbound
  • Progressive decline, in spite of curative treatments.

*Samaritan’s goal is to care for you and your family if you have a life-limiting illness and are seeking comfort care. The type of life-limiting illness does not matter. 


When is the Right Time to Ask About Hospice?

Now is the best time to learn more. Although end-of-life care may be difficult to discuss, it’s best for family members to share their wishes long before it becomes a concern.

Hospice care isn’t giving up. It’s ensuring that your loved one or patient is as comfortable as possible during the time he or she has left.

What Are The Hospice Eligibility Criteria for Specific Illnesses?

The general hospice eligibility criteria above apply to any illness or diagnosis. But many patients and families wonder how these general criteria apply to their specific illness. Let’s explore the criteria if you or someone you care for is living with advanced cancer, heart disease, or dementia. There are also specific criteria available on our site for ALS, HIV, Kidney Disease, Lung Disease, and Stroke.

Note: Not every eligible patient will have every disease “trigger” for hospice care.  When in doubt, please call our Referral Center at (800) 229-8183 to discuss your specific needs or questions. You may also request to arrange a visit to see if you are eligible for hospice care, or for other services such as palliative care.

Hospice Eligibility Criteria for Cancer

Sick older woman with cancer with inner strength to fight with disease

People living with advanced cancer may be eligible for palliative care from the time of diagnosis to relieve their pain and anxiety, and control other symptoms. Palliative care is available at the same time patients are receiving curative treatments. Our staff will work with patients’ family physicians or specialists to “connect the dots” for their best quality of life.

Patients become eligible for hospice care if they meet one or more of the following criteria:

♦ Patient has notable weight loss that is not intentional
♦ Cancer has spread beyond the first site (Metastatic disease)
♦ Cancer enters a more advanced stage despite therapy to cure or slow it
♦ Patient wishes to stop curative treatment Note: Palliative radiation (radiation given to ease discomfort rather than cure) may be continued when necessary.
♦ Patient wishes to remain out of the hospital if the disease gets worse
♦ Patient has more than one serious medical condition that may shorten survival (e.g. lung cancer with COPD). Your doctor may call this a comorbid condition.
♦ Patient needs more help with basic tasks of daily living

Hospice Eligibility Criteria for Heart Disease

Man with chest painsAccording to the National Institutes of Health, an estimated 5.8 million people are living with the advanced heart disease known as Congestive Heart Failure (CHF). Almost 700,000 people are diagnosed with the disease each year.

In CHF, the heart wears down and becomes less able to pump blood in to receive oxygen and out to deliver that oxygen throughout the body. When this pump is not working well, every body system is affected.

Living with advanced heart disease can be a daily challenge for patients and their caregivers. Symptoms such as chest pain (angina), feeling short of breath even while at rest, fluid retention and swelling, severe fatigue, dizziness, and irregular heartbeat often prompt anxiety and depression. Patients and families often find themselves making repeated trips to the emergency room or being readmitted for stressful hospital stays.

People living with advanced heart disease are eligible for hospice care if they meet one or more of the following criteria:

♦ Having CHF symptoms in spite of using medications to relieve fluid retention (diuretics) and improve circulation (vasodilators).
♦ Medical history of cardiac arrest
♦ Angina (sharp chest pain) at rest despite medical efforts to relieve it
♦ Angina at rest and patient is not a candidate for surgery, or refuses surgery
♦ New York Heart Association Class IV disease: Physicians use this system to place patients in one of four categories based on how much they are limited during physical activity. Patients in Class IV are unable to carry on any physical activity without discomfort and show CHF symptoms at rest.
♦ Ejection Fraction (EF) of less than 20%: Ask your doctor about your score on this test to measure how well your heart is pumping out blood. The EF for a normal heart ranges between 50 and 70.
♦ Abnormally fast heart rhythm (known as symptomatic SVT or ventricular arrhythmia) that does not respond to treatment.
♦ Unexplained fainting (also known as syncope)
♦ A blockage that formed in the heart and lodged in the brain (called a cardiogenic brain embolism)
♦ Patient wishes to remain out of the hospital if the illness gets worse
♦ Patient has more than one serious medical condition that may shorten survival (e.g. CHF with COPD)
♦ Patient needs more help with basic tasks of daily living

Hospice Eligibility Criteria for Dementia

Portrait of an elderly woman sitting alone in a senior care facilityWhen hospice care began in the 1960’s, the majority of its patients were living with cancer. However, people in the late stages of any serious illness are eligible for hospice care. This includes people living with advanced Alzheimer’s Disease, and related conditions like vascular dementia, Lewy Body dementia, and frontotemporal dementia.

Unlike other serious illnesses, determining life expectancy and the exact timelines for the advanced stages of Alzheimer’s and other dementias can be very difficult. Family caregivers and their loved one’s physician may find it hard to decide when to call hospice, especially if the patient has become unable to communicate things like pain or other symptoms.

In general, people living with Alzheimer’s Disease or related dementias may be eligible for hospice care when they exhibit one or more of the following hospice admission criteria:

    • Difficulty speaking intelligibly
    • Difficulty sitting up
    • Difficulty smiling or holding up the head
    • Bed sores (also called decubitus ulcers)
    • Infection during the past year — such as pneumonia, kidney infection (pyelonephritis), bloodstream infection (sepsis) — or a fever that recurs after antibiotics
    • Severe weight loss
    • Difficulty in taking in food or drink by mouth
    • Patient wishes to stay out of the hospital if the illness gets worse. Since it may be difficult for the patient to share his/her wishes in the late stages of dementia, it is so important to have these important discussions while conversation is still possible.
    • Patient has more than one serious medical condition that may shorten survival (e.g. dementia and pneumonia). Your physician may call this a comorbid condition.
    • Patient depends on others for basic tasks of daily living.

Samaritan has many ways to help. 

We encourage you to speak directly with our nurses about the admission criteria for hospice care and how we can help with your patient’s or loved one’s needs. Call us 24/7 at (800) 229-8183.

Inpatient Hospice Care Criteria

Most hospice care is given in the comfort of the patient’s home or in the long-term care community where the patient lives. Sometimes, severe pain or other symptoms require an advanced level of care that is better provided during a short stay in an inpatient hospice facility such as the Samaritan Center at Mount Holly or the Samaritan Center at Voorhees. If your loved one’s needs intensify, your Samaritan hospice team may recommend transferring him or her to the inpatient level of hospice care. Other patients with severe pain or symptoms may be admitted to inpatient hospice care directly from a hospital stay.

The goal of our NJ inpatient hospice care is to control severe pain and symptoms so that your loved one can return home to family and familiar surroundings, if possible, and resume hospice care at home.

The following inpatient hospice facility criteria are used to evaluate whether your loved one or patient is ready for hospice care. Please note that not all of the below inpatient hospice criteria are needed.

  • Pain or symptom crisis not managed by changes in treatment in the current setting or that requires frequent medication adjustments and monitoring
  • Intractable nausea/vomiting
  • Advanced open wounds requiring changes in treatment and close monitoring
  • Unmanageable respiratory distress
  • Intractable delirium with behavior issues
  • Sudden decline necessitating intensive nursing intervention

When Our South NJ Inpatient Care is Not Appropriate:

Medicare guidelines indicate that inpatient hospice care at a facility is NOT intended for the following.

  • Caregiver respite: If a caregiver is not in the home, or unable to help the patient adequately, other arrangements can or should be made.
  • As a way to address unsafe living conditions in the patient’s home. As an “automatic” level of care when a patient is imminently dying.
  • There must be pain or symptom management and skilled nursing needs present (intensity of care).

What services do we offer at our South NJ Inpatient Facility?

Inpatient hospice care is the choice when severe pain or other symptoms require an advanced level of care that is more effectively provided during a short stay in an inpatient hospice facility.

If your patient or loved one’s needs intensify, the hospice team may recommend transferring him or her to the inpatient level of hospice care. If your patient or loved one is in the hospital because of intense pain or symptoms due to serious illness, and meets the inpatient-hospice criteria, the hospital staff may recommend transferring him or her also.

South Jersey residents experience inpatient hospice care at our dedicated facilities in Voorhees and Mount Holly.

Samaritan’s two inpatient centers feature peaceful, home-like environments. The inpatient staff provides round-the-clock symptom relief for the comfort of your loved one. Your hospice nurse will work with you and your family to determine which Center is best for you.

Do you believe that your patient or loved one matches the requirements for inpatient hospice care in NJ?
Note: Not every eligible patient will exhibit every referral trigger. When in doubt, please call our Referral Center at (800) 229-8183 to learn more about hospice inpatient care criteria, discuss your patient’s specific needs, or to arrange for an assessment visit. 


Additional Resources

For Healthcare Professionals

Mature Female doctors posing smiling looking at the cameraWe hope you find the information regarding what qualifies a patient for hospice admission helpful in your practice. Since every patient’s needs are different, you may still have some questions regarding whether a particular patient meets the admission criteria for hospice. Or perhaps you’d like more information on the right time to refer, or how to decide between palliative or hospice services for particular patients in your care? Samaritan can help.

We can provide you information about how the hospice patient admission process works, and help you in making the best decision for your patient and his/her family throughout the course of illness. Remember, hospice and palliative care is not giving up. Instead, it’s an extra layer of support ensuring that your patient is as comfortable as possible during the time he or she has left, and that his/her family is supported in their caregiving.

 

Samaritan Hospice & Palliative Patient Referral Form

Portrait of grandfather and grandsonSamaritan welcomes hospice and palliative referrals, or inquiries, from patients, family caregivers, or healthcare professionals.

Please fill out the form  if you would like to refer yourself, a loved one, or one of your patients to our hospice or palliative care program. A staff member will be in touch with you within 24 hours to answer your questions or begin the admission process. You may also call us anytime, any day at 1-800-229-8183.