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Are You Hospice Eligible?

Know the signs of when it may be the right time to choose hospice. With Hummingbird Hospice, we will tailor a care plan that meets the unique needs of a specific condition or illness. 

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An Overview of Hospice Care

"When discussing hospice, the goals for patients and family members to understand is that it is basically about switching the focus of care. It's not so much about fighting a disease, it's more about that individuals needs as they are nearing the end of their life. Hospice is truly about making every day that they have remaining on this earth the best that it possibly can be."                                                          - Dr. Laura Matone

Hospice Care

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  • Provides support and care for those in the last phase of a life-limiting illness.

  • Recognizes dying as a part of the normal process of living.

  • Affirms life and neither hastens nor postpones death.

  • Focuses on quality of life for individuals and their family caregivers. 

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Customized Care Plan

A person experiencing symptoms relating to dementia should have different care provided than an individual with a renal condition. Each person is different, and their care plan should be reflective based on the special care they need for their life-limiting illness.

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The following information can be used to help determine if it is the right time to consider hospice. 

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Alzheimer's Disease

Hospice can help individuals experiencing symptoms relating to Alzheimer’s Disease and forms of dementia by relieving anxiety, controlling pain, and improving quality of life.

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Here are a few signs to recognize for hospice eligibility:

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  • Inability to move independently, requiring assistance

  • The patient is at or beyond stage 7 of the FAST (Functional Assessment Staging) scale

  • Unable to bathe or dress without assistance

  • Incontinence of bladder and/or bowel

  • Inability to speak or communicate meaningfully

 

Here are also a few criteria related to complications due to dementia. Have you or your loved one experienced one or more of the following in the past year:

  • Aspiration Pneumonia

  • Septicemia

  • Decubitus Ulcer, stage 3-4

  • Recurrent fever after antibiotic treatment

  • Weight loss, greater than 10% in the last 6 months

  • Serum albumin, less than 2.5 gm/dl

  • Urinary Tract Infection (UTI)

  • Inability or unwillingness to take food or fluids

Cancer

As there are many different types of cancer, the following hospice cancer criteria are general rules used to determine if hospice is the right choice for a patient.

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Clinical hospice cancer criteria may include:

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  • A metastatic cancer diagnosis

  • Demonstrates decline in condition in spite of therapy efforts

  • Received a Palliative Performance Score or Karnofsky Score of 70% or less by a primary care physician

  • Electing to forgo further disease-directed curative treatment

 

If a cancer patient is eligible for hospice, the Hummingbird Hospice team provides comprehensive symptom management for a wide range of cancer-related issues. It is important to start the hospice conversation as early as possible, giving you the time to explore all available options and to gather what information you may need before a crisis occurs.

Chronic Obstructive Pulmonary Disease (COPD)

When an individual begins to experience one or more of the following criteria, it may be time to bring on the additional support of hospice care.

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  • Recent visits to the ER or hospitalization for pulmonary infections or respiratory failure

  • Dyspnea, or tightness in the chest

  • Identification of specific structural/functional impairments

  • Relevant activity limitations

  • Changes in appetite and unintentional & progressive weight loss

  • Impaired sleep functions

  • Decline in general physical endurance

  • Impaired mobility

  • Requires oxygen some or all of the time

  • Requires breathing treatments or use of inhalers

  • Difficulty eating or carrying on conversations without becoming short of breath

 

Individuals with other types chronic lung or restrictive airway diseases may be experiencing the following:

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  • Disabling dyspnea at rest

  • Poorly unresponsive to bronchodilators resulting in decreased functional capacity

  • Increased visits to the ER or hospitalized for pulmonary infections and/or respiratory failure

 

Any of these criteria can also be accompanied by:​

  • Persistent hypercapnia (pCO2 greater than or equal to 50 mmHg)

  • Cor Pulmonale, or right heart failure (Secondary to pulmonary disease)

  • Resting tachycardia, less than 100 bpm

  • Has become steroid-dependent

  • Unintentional progressive weight loss of greater than 10% body weight in past 6 months.

Cerebrovascular Accident (Stroke)

The following criteria could be indicators that it may be a good time to consider the additional support of hospice. 

Have you noticed any of the following in recent months:

  • Have received a Palliative Performance Score, or Karnofsky Score, of 40% or less from a primary care physician

  • Mainly bed or wheelchair bound

  • Increasingly impaired functional status, requiring assistance remembering daily tasks or routines

  • Requires assistance with activities of daily life (ADLs)

  • Unable to maintain sufficient fluid and caloric intake with a decrease in eating or drinking

  • Demonstrates progressive weight loss

General Requirements for Hospice Eligibility

Like anything else that is Medicare and Medicaid regulated, there are a whole list of eligibility requirements to determine who and how someone receives hospice services.  LCD provides doctors a list of criteria to go through prior to making a prognosis. Medical schools teach students how to save lives, so many have never been taught the art of prognostication.  However, these specific guidelines are required to make it easier for such medical decisions.

Eligibility Requirements

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  • Medicare hospice coverage depends upon a physician's certification of a life expectancy of 6 months or less if the terminal illness runs it's normal course.

  • The physician's clinical judgment must be supported by "clinical information and other documentation" that provide a basis for a life expectancy of 6 months or less.

  • Medical necessity must be evaluated and clearly and objectively documented in the clinical record.

  • Recognizing that determination of life expectancy during the course of a terminal illness is difficult, CMS established LCD guidelines ("medical criteria") for determining prognosis for cancer and non-cancer diagnoses.

  • LCD = "Local Coverage Determination"

    • Created to assist in determining eligibility based upon disease severity and burden of illness​.

    • Allows for decline of the beneficiary's condition to be a factor in determining prognosis.

    • Many do not reflect current research or medical information on prognosis.

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General Decline in Health

Sometimes end-of-life is presented by an overall decline in health for hospice patients. 

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Do any of the following apply:

  • Have been hospitalized or visited the ER multiple times in the past 6 months

  • Fallen on several occasions over the past 6 months

  • Experienced weight loss, which has made clothes look noticeably looser

  • Decrease in appetite

  • Started medication for pain management

  • Spends most of the day in a chair or bed

  • Started needing help with Activities of Daily Life (ADLs)

  • Reports a loss of energy or are sleeping more

  • Noticing a shortness of breath, even while resting

Chronic Heart Failure or Heart Disease

Individuals with CHF or other types of end-stage cardiac conditions are good indications of hospice eligibility.

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  • Identification of specific structural/functional impairments

  • An ejection fraction of less than 20% (This is not a requirement, but is an important consideration)

  • A poor response to diuretics and vasodilators

  • Dyspnea, or tightness in the chest

  • Expressing chest pain

  • Impaired heart rhythms, contraction force of ventricular muscles, and impaired blood supply to the heart

  • Changes in appetite, unintentional weight loss

  • Impaired sleep functions, changes in sleeping patterns

  • Decline in general physical endurance

  • Relevant activity limitations and or impaired mobility

Liver Disease

Look for these signs that come to a point that all involved may benefit from hospice services:

  • Weakness and compromised ability perform Activities of Daily Life (ADLs)

  • Recurrent variceal hemorrhages

  • Hepatic encephalopathy

  • Prothrombin time prolonged more than five seconds over control (INR > 1.5)

  • Serum Albumin < 2.5 gm/dl

  • Diagnosed with Peritonitis

  • Elevated creatinine and BUN with Oliguria <400 ml/day and urine sodium concentration <10 mEq/l

  • Ascites

  • Asterixis

  • Demonstrates malnutrition or muscles wasting

Decline in Neurological Condition

Due to the progressive nature of neurological conditions associated with non-Alzheimer’s dementia, such as Parkinson's, MS, ALS, Huntington’s Disease, and others, it can be challenging for families to know the right time for hospice support. Hummingbird Hospice is available for family/patient informational discussions to determine what is right for you.

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  • Impaired mental function

  • Impaired sensory function and pain

  • Impaired neuromusculoskeletal and movement functions

  • Impaired communication or unintelligible speech

  • Impaired mobility and/or rapid progression to becoming wheelchair or bed bound

  • Self-care deficit, or inability to perform Activities of Daily Living (ADLs)

  • Dyspnea at rest, or requiring supplemental oxygen at rest

  • Inability to eat or drink sufficiently

  • Additional comorbidities or complications that exacerbate the degenerative neurological condition, including pneumonia, sepsis, pyelonephritis, or decubitus ulcers

Hummingbird is Here to Help

Hummingbird Hospice is the right choice for the best quality of care for you and your loved ones. 

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Contact us today to speak with a patient care representative and learn more about our specialized services and offerings. 

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