Hospice Eligibility, Referrals, and Admission Processes

1. Patient Eligibility for Hospice Care

Patients can receive hospice services only if they meet eligibility criteria determined by the insurance payer. Most payers require the patient to have a limited life prognosis of six months or less and for that prognosis to be certified by a physician. Medicare sets many of these standards and is the largest payer for hospice care in the US. This chapter describes hospice eligibility and defines additional specific clinical guidelines for health care clinicians to use when considering patient referral to hospice services.

2. Timing and Referral to Hospice Care

The goal of hospice care is to provide comfort to patients through management of their symptoms and preparation for death and bereavement for patients and their families/caregivers. This chapter outlines optimal referral timing and the referral process to hospice care. Hospice is unique in that the patient and family are the unit of care. This chapter also discusses the importance of the timing of a patient's referral to hospice care and the benefits of timely referral.

3. Increase of Short Length of Patient Stay in Hospice

Most individuals are referred to hospice in a timely manner, but an upward trend over the past several years shows that many patients are not referred early enough to receive a comprehensive hospice experience. This chapter examines the growing short-length-of-stay phenomenon and its link to patient referral timing.

4. Admission to Hospice Care

The process of admission to hospice care includes a comprehensive assessment of the patient’s physical, emotional, psychosocial, and spiritual status and needs. The admission also assesses the emotional, psychosocial, and spiritual status and needs of the patient’s family/caregiver. The assessment outcomes are utilized to develop an individualized plan of care that changes as the status and needs of the patient and family/caregiver change. The assessment of needs drives updates to the plan of care. This chapter will explain the hospice admission process of the hospice interdisciplinary team. This chapter also examines a case study related to patient referral and admission to hospice care.