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Hospice Eligibility
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We understand that each person's path through a life-limiting illness is unique. As a result, we believe in offering personalized care plans to meet the specific needs of our patients. We make certain that each patient's care plan is constantly updated to reflect their current situation. Our team of healthcare professionals is dedicated to providing compassionate care, taking into account each patient's unique condition while developing a care plan. We collaborate closely with patients and their loved ones to develop an effective and reassuring care plan that provides the much-needed support they seek during this difficult time.
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Hospice Eligibility
How can hospice care help?
At its essence, hospice care revolves around prioritizing the individual receiving care as well as their family caregivers. Focusing on symptom management, emotional, and spiritual support, our main objective is to enhance the quality of life during these potentially challenging moments. Most importantly, we strive to deliver empathetic care that upholds the dignity and comfort of everyone involved.
Alzheimer's Disease

If you or a loved one is struggling with symptoms associated with Alzheimer's Disease or other forms of dementia, Hospice can provide relief from anxiety, pain management, and improved quality of life.


Signs and symptoms:

As a caring resource, we want you to be aware of the signs of hospice eligibility. These may include difficulty moving without assistance, reaching stage 7 of the FAST scale, needing help with bathing and dressing, experiencing bladder and/or bowel incontinence, and struggling to communicate effectively. Recognizing these signs can help ensure your loved one receives the compassionate care they need.

Alternatively, if you or your loved one has experienced one or more of these issues in the past year, it may also be time to start considering hospice:

  • Stage 3-4 Decubitus Ulcer

  • Greater than 10% weight loss in the last 6 months

  • Serum albumin less than 2.5 gm/dL

  • Recurrent fever after antibiotic treatment

  • Urinary Tract Infection (UTI)

  • Inability or unwillingness to take food or fluids

  • Septicemia

  • Aspiration Pneumonia


We know that cancer can manifest itself in various ways, and that can be overwhelming. Our compassionate team assesses each patient using standard guidelines to determine whether hospice care is the right choice. Our clinical criteria include factors such as having metastatic cancer, experiencing worsened symptoms despite treatment, receiving a low Palliative Performance or Kornofsky Score from your doctor, and deciding not to pursue further curative treatment. We're here to provide personalized, supportive care during this difficult time.


Our team fully understands the challenges that come with cancer-related issues. All of our staff are specially trained to offer complete symptom management to patients who qualify for hospice care. We highly encourage you to discuss hospice care early on so that you can have enough time to explore every available choice and gather all the information you need before a crisis arises.

Chronic Obstructive Pulmonary Disease (COPD)

If you or someone you love is experiencing one or more of the issues below, it could be time to start considering hospice.


  • Visits to the emergency room or hospitalization due to pulmonary infections or respiratory failure recently.

  • Experiencing difficulty breathing or tightness in the chest, also known as dyspnea.

  • Specific structural or functional impairments have been identified.

  • Limitations in activities that are relevant to the patient's condition.

  • Changes in appetite leading to unintentional and progressive weight loss.

  • Impaired sleep functions.

  • A decline in general physical endurance.

  • Poor mobility, which affects the patient's ability to move around.

  • Requiring oxygen some or all of the time.

  • Requiring breathing treatments or inhalers for breathing difficulties.

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

Symptoms of other chronic lung diseases may include:
  • Dyspnea that is severe enough to cause disability, even at rest

  • Limited relief from bronchodilators, resulting in decreased ability to perform daily activities

  • Frequent emergency room visits or hospitalizations due to pulmonary infections or respiratory failure

These symptoms may also be accompanied by:

  • Presence of persistent hypercapnia with pCO2 levels equal to or greater than 50 mmHg

  • Cor Pulmonale, which is a type of right heart failure that occurs secondary to pulmonary disease

  • Resting tachycardia with a heart rate of less than 100 bpm

  • Dependence on steroids for symptom management

  • Unintentional and progressive weight loss of more than 10% of body weight in the past six months.


If you or your loved on is a recent stroke survivor but is suffering from any of the following symptoms, it may be time to consider additional support from a hospice:

  • A primary care physician has given a Palliative Performance Score or Karnofsky Score of 40% or less.

  • Mostly confined to bed or wheelchair.

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

  • Needs help with activities of daily life (ADLs).

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

  • Showing signs of progressive weight loss.

Hospice eligibility requirements

To be eligible for Medicare hospice coverage, a physician must certify that a patient's life expectancy is 6 months or less if the terminal illness runs its diagnosed course. The physician's clinical judgment must be supported by clinical information and other documentation that demonstrates a basis for a 6-month life expectancy. The medical necessity must be evaluated and clearly and objectively documented in the clinical record.


Since determining life expectancy during a terminal illness is difficult, CMS established LCD guidelines (Local Coverage Determination) to assist in determining eligibility based on disease severity and burden of illness. The LCD guidelines take into account the decline of the beneficiary's condition when determining prognosis. However, many of these guidelines do not reflect current research or medical information on prognosis.


With Medicare and Medicaid regulations in place, a list of requirements must be met to ensure that your loved one is eligible for hospice services. Our trusted doctors follow specific guidelines outlined by the Local Coverage Determination (LCD) to evaluate your loved one's condition and make the best possible prognosis.

General health decline
  • As hospice caregivers, we understand that a gradual waning of health can often characterize end-of-life. Symptoms of this include:


  • Has had multiple hospitalizations or visits to the emergency room in the last 6 months

  • Has experienced multiple falls over the past 6 months

  • Has noticed weight loss resulting in visibly looser clothes

  • Has experienced a decrease in appetite

  • Has started taking medication for pain management

  • Spends a significant amount of time confined to a bed or chair

  • Has started requiring assistance with Activities of Daily Life (ADLs)

  • Reports feeling fatigued or sleeping more than usual

  • Experiences shortness of breath, even while at rest

Chronic heart failure or heart disease

As hospice caregivers, we understand that a gradual waning of health can often characterize end-of-life. Symptoms of this include:

  • Shortness of breath or chest tightness

  • Reporting chest pain

  • Limited response to diuretic and vasodilator medication

  • Impaired heart rhythms, ventricular muscle contraction force, and decreased blood supply to the heart

  • Ejection fraction below 20% (not a requirement, but an important factor to consider)

  • Appetite changes and unintended weight loss

  • Impaired sleep and alterations in sleeping patterns

  • Decreased overall physical endurance

  • Relevant limitations in activities or impaired mobility

Liver disease
  • Hospice services may be beneficial for individuals when these signs become apparent:

  • Weakness and difficulty performing Activities of Daily Life (ADLs)

  • Experiencing recurrent variceal hemorrhages

  • Showing signs of hepatic encephalopathy

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

  • Serum Albumin level is below 2.5 gm/dl

  • Diagnosed with peritonitis

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

  • Developing ascites

  • Exhibiting asterixis

  • Demonstrating signs of malnutrition or muscle wasting

Neurological decline

We understand that the progression of neurological conditions like Parkinson's, MS, ALS, Huntington’s Disease, and other non-Alzheimer’s dementias can be overwhelming for families. Deciding when to seek hospice support can be a tough decision. If you or your loved one is starting to show any of the below symptoms, it may be time to start considering hospice care:


  • Cognitive impairment or decline in mental function

  • Impaired senses or pain perception

  • Impaired neuromuscular or movement function

  • Difficulty communicating or unintelligible speech

  • Limited mobility and/or quickly becoming bedridden or wheelchair-bound

  • Inability to perform Activities of Daily Living (ADLs) without assistance

  • Resting dyspnea or need for supplemental oxygen at rest

  • Inability to consume adequate food or liquids

  • Co-occurring conditions or complications that worsen the degenerative neurological condition, such as pneumonia, sepsis, pyelonephritis, or pressure ulcers.

Bluevine can help

We understand that you and your loved ones deserve the best possible care. That's why our team of compassionate professionals specializes in offering top-quality services that cater to your unique needs. No matter what you're going through, we're here to support you every step of the way. Reach out to us today to connect with one of our patient care representatives and discover how we can make a difference.​

For Referrals Call (832) 751-8333
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