Hospice Admission Criteria Policy

Hospice staff shall admit patients with a terminal illness who meet the admission criteria. To establish standards and the process which Hospice staff evaluates and admit patients.

Procedure

1. Hospice services are available to patients of all ages, incomes, ethnicities, gender, disability, and cultural backgrounds who:
   1. Have a life-limiting illness if the disease follows its normal course. Life-limiting illnesses include cancer, pulmonary disease, heart disease, renal failure, Alzheimer's disease, ALS (Lou Gehrig's disease), AIDS, stroke/coma, etc.
   2. Have a prognosis of six months or less. Care continues beyond six months if the hospice medical director continues to certify a six-month prognosis; and
   3. Have decided that the primary goal of treatment is no longer cure but rather comfort. The patient must have chosen to forego aggressive, curative treatment. Comfort takes the form of palliative care. This is the active total care of the body, mind and spirit. The purpose of palliative care is to prevent or lessen the severity of pain and other symptoms and to achieve the best quality of life for people dying or suffering from a life-limiting disease.
2. Admission into hospice may still be appropriate for patients not meeting these specific criteria when the patient has co-morbidities or rapid decline from two or more combined disease processes.
3. The patient's diagnosis, clinical findings, or condition meets the current National Government Services Local Coverage Determination guidelines for determining hospice coverage.
4. Initial referrals are accepted from the primary physician, social worker, nurse, patient, family, or any other providers/participants in the patient’s care. The patient may be certified by the patient’s primary physician and the Agency’s Medical Director. The Agency’s HHC/Hospice Supervisor will request medical records from the patient’s medical providers to support the need for Hospice care.
   1. The Agency will not discriminate against any potential patient or family including but not limited to age, race, gender, cultural background, disability, marital status, sexual orientation, or military status.
   2. The Agency will attempt to admit the patient as soon as the Agency is able to based on staffing, patient need, and having the appropriate orders and paperwork completed.
   3. The Agency has the right to deny a referral for any reason (excluding those listed in 4a) including, but not limited to: history of verbal or physical abuse to staff, no active payer source, unsafe home situation, the patient lives outside of the service area, the patient is not eligible for hospice, or if the Agency does not have the appropriate resources or staff to manage the patient’s complex medical needs.
5. The patient and family have been made aware of the diagnosis and consent to hospice services.
6. The patient lives in the Agency’s service area.
7. The patient's attending physician agrees to admission, supports the hospice plan of care, and provides medical orders for service.
8. The patient has an appointed primary caregiver or will allow hospice to assist with care giving arrangements, when necessary.
9. If the patient, family, and primary physician agree to begin Hospice services and the patient is eligible, the Agency’s HHC/Hospice Supervisor will fax the following to the patient’s primary physician:
   1. Certificate of Terminal Illness
   2. Comfort Kit Orders
   3. Hospice standing Orders
   4. Upon return of these items, the Certificate of Terminal Illness will be sent to the Agency’s Medical Director along with medical records to review. If the Agency’s Medical Director signs the Certificate of Terminal Illness, the patient will be admitted to Hospice.