Criteria for Progressive Decline to Qualify for Hospice Care

General Eligibility Requirements

The American College of Chest Physicians and other medical organizations require certification that the patient's prognosis is terminal, meaning more likely than not to have less than 6 months of life remaining, as determined by both the treating physician and hospice medical director 1, 2
Patients must agree in writing that hospice care will be used to treat their terminal illness, and they do not need a "do not attempt resuscitation" order to be enrolled in hospice programs 1
The Centers for Medicare and Medicaid Services require that patients can be withdrawn from hospice programs if their condition unexpectedly improves 1

The American Thoracic Society recommends that patients with advanced lung disease qualify for hospice if they have severe chronic lung disease, as documented by disabling dyspnea at rest and evidence of disease progression 3
The American College of Chest Physicians suggests that patients with advanced lung disease also qualify for hospice if they have hypoxemia at rest on ambient air or hypercapnia 3
Supporting criteria for hospice eligibility in advanced lung disease include right heart failure secondary to pulmonary disease, unintentional progressive weight loss, and resting tachycardia 3

The American Journal of Respiratory and Critical Care Medicine notes that current prognostic criteria for non-cancer illnesses have limitations in accurately predicting 6-month mortality, and the BODE index provides prognostic information for COPD but has not been validated for determining 6-month mortality 4

The Journal of Hepatology suggests that the "surprise question" can help identify patients who would benefit from palliative care measures 5

Many physicians are unaware of hospice eligibility criteria for non-cancer patients, leading to delayed referrals, according to the American Journal of Respiratory and Critical Care Medicine 1, 6
The American College of Chest Physicians notes that prognostic uncertainty often serves as a barrier to timely hospice referral, and physicians may be reluctant to discuss hospice due to lack of skill in communicating that death is near 1
There is a misconception that hospice is only for the last hours to days of life, when earlier referral is associated with better outcomes, as stated by the American Journal of Respiratory and Critical Care Medicine and Praxis Medical Insights 1, 6

A patient refusing treatment for sepsis can qualify for hospice if a physician and hospice medical director certify that the patient's prognosis is terminal, and the patient agrees in writing to receive only hospice care rather than curative treatment for their terminal illness 7
The patient must agree in writing that only hospice care will be used to treat their terminal illness 7
Patients do not need a "do not attempt resuscitation" order to enroll in hospice, as it is illegal under the Patient Self-Determination Act for Medicare-funded hospice programs to exclude patients who don't agree to forgo CPR 7

The physician must document that without treatment, the patient's sepsis will likely result in death within 6 months 7
Ensure the patient understands the consequences of refusing treatment and that this decision is consistent with their goals of care 8
The Surviving Sepsis Campaign recommends discussing goals of care and prognosis with patients and families, incorporating these into treatment and end-of-life care planning using palliative care principles 8
Goals of care should be addressed as early as feasible, but no later than within 72 hours of ICU admission 8

The American Thoracic Society emphasizes that establishing realistic treatment goals is important in promoting patient-centered care, and discussing prognosis for achieving goals of care has been identified as an important component of surrogate decision-making 8
The physician certifying hospice eligibility does not guarantee death within 6 months, and Medicare will continue coverage if enrollment criteria are still met 7
Patients can be withdrawn from hospice programs if their condition unexpectedly improves, such as if they change their mind and accept treatment 7
Many physicians are unaware that patients refusing life-sustaining treatment can qualify for hospice 9