After experiencing the unique care hospice provides, we have many patients and families who have said they wish they would have called hospice earlier. Although it is difficult to know exactly when to call hospice there are some signs to look for that may help decide.
- Has your loved one had multiple hospitalizations and stated they no longer want to go to the hospital?
- Has it become increasingly difficult to go to the doctor’s office?
- Has your physician stated the disease has progressed and they are no longer able to cure the disease?
These are some of the indications that it may be time for hospice. Here at Hope Hospice we are available to speak with you to answer any questions you may have.
Hospice services are available to patients with life-limiting illnesses who can no longer benefit from curative treatment. Patients have life expectancies of six months or less if the disease follows its normal course as determined by a physician. Recognizing that determination of life expectancy during the course of a terminal illness is difficult, the National Hospice and Palliative Care Organization has published medical criteria for determining prognosis of certain diagnoses. These guidelines form a reasonable approach to the determination of life expectancy based on available research and the most current information. Some patients may not meet the criteria, but may still be eligible for hospice care based on other co-morbidities or rapid functional decline. It is the physician’s clinical judgment regarding the normal course of the patient’s illness that determines a prognosis of six months or fewer. We are dedicated to providing hospice care to all people who are eligible for hospice services regardless of their diagnosis or ability to pay. The Medicare criteria for hospice guide is designed to assist physicians in determining hospice appropriateness.
Hospice appropriate diagnoses
There are specific criteria for hospice eligibility for a variety of conditions, including: Cancer Alzheimer’s/Dementia HIV/AIDS Kidney/Renal Disease Liver Disease Pulmonary Disease (COPD) Cardiovascular Disease Stroke/coma Unspecified Debility/Failure to thrive (Non-Specific Terminal Illness) Neuromuscular Diseases: Amyotrophic Lateral Sclerosis (ALS) Multiple Sclerosis (MS) Parkinson’s Disease Huntington’s Disease. For more information or questions, call us at (951) 679-8872. We are here to help.
Medicare criteria for hospice care reimbursement
“The certification of terminal illness of an individual who elects hospice shall be based on the physician’s or medical director’s clinical judgment regarding the normal course of the individual’s illness.” Department of Health and Human Services, Health Care Financing Administration, January, 2001
- Progressive disease with increasing symptoms and/or worsening lab values and/or decreasing functional status and/or evidence of metastatic disease, particularly brain.
- Stage IV at initial diagnosis; Stage III with pleural effusion; or Stage II with patient continuing to decline despite definitive therapy
- Karnofsky Performance Status < 70 or Palliative Performance Score < 70%
- Significant hemoptysis
- Superior vena cava syndrome
- Lymphangitic lung involvement
- Recurrent pneumonia (two or more episodes in three months)
- Laboratory abnormalities:
- LDH > twice normal
- Albumen < 2.5
- Calcium > 14
- Weight loss of five percent or more in the last three months due to progressive disease, or irreversible dysphagia or loss of appetite;
- Presence of severe co-morbidities that contribute to a life expectancy of six months or less, including but not limited to:
- Chronic obstructive pulmonary disease
- Congestive heart failure
- Diabetes mellitus
- Neurologic disease (CVA, ALS, MS)
- Renal failure
- Liver disease
- Acquired immune deficiency syndrome (AIDS)
- Recurrent disease after surgery/radiation/chemotherapy.