Also Known As:
Hospice admission criteria, qualifying for hospice, hospice qualification, six-month prognosis
Type:
Patient admission criteria
Primary Purpose:
To determine whether a patient qualifies for the Medicare Hospice Benefit based on a physician-certified terminal prognosis.
When It Applies:
Anytime a patient or family is considering hospice. Eligibility is re-certified at intervals through the hospice stay.
Who Is Involved:
The patient’s attending physician, the hospice medical director, and the admitting nurse who completes the clinical review.
Where It Occurs:
Reviewed at home, at the bedside, or by chart review.
Duration:
Initial certification is for 90 days; the patient is re-certified at 90 days, 90 days, and then every 60 days for as long as eligibility continues.
Coverage:
Once eligibility is certified, Medicare, Medicaid, and most private insurance cover hospice in full.
Key Focus:
A six-month-or-less prognosis if the disease runs its expected course, plus disease-specific markers (FAST scale, NYHA Class, weight loss, functional decline, recurrent infections).
Common Misunderstanding:
Eligibility does not end after six months. Many patients live longer than six months in hospice, and as long as they continue to show decline and meet criteria, they remain eligible.
The Core Eligibility Standard
Under Medicare rules, a patient qualifies for hospice when two physicians, usually the patient’s attending physician and the hospice medical director, certify in writing that the patient has a life expectancy of six months or less if the disease runs its expected course.
The certification is renewed at 90 days, again at 90 days, and then every 60 days. Many Lifted patients receive hospice care for far longer than six months because their decline continues to meet criteria. Read our full eligibility guide.
Disease-Specific Markers
Beyond the six-month prognosis, each disease has its own clinical markers that help physicians and hospice teams confirm eligibility:
- Cancer: Metastatic disease, declining performance status, weight loss, withdrawal from curative treatment
- Alzheimer’s / dementia: FAST Stage 7 plus a complication like aspiration pneumonia or recurrent UTI
- Heart disease: NYHA Class IV, optimized medications, recurrent hospitalizations, low ejection fraction
- Lung disease: Disabling dyspnea at rest, oxygen-dependent, cor pulmonale, recurrent pneumonia
- Renal disease: Discontinuing dialysis, severe symptoms, signs of uremia
- Liver disease: End-stage cirrhosis with refractory ascites, hepatorenal syndrome, encephalopathy
- Stroke / neurological: Severe functional decline, recurrent aspiration, significant weight loss
- Multi-system decline / failure to thrive: Significant weight loss, decline in functional status, recurrent infections
How to Know If Your Loved One Qualifies
The most reliable way to find out is to request a free, no-pressure hospice assessment. A Lifted nurse will review the clinical picture, talk with the family, and give an honest answer, yes, no, or not yet.
You don’t need a physician’s referral to request the assessment. We coordinate the physician sign-off afterward. Begin a conversation or call (972) 777-3000.