St. Gabriel's Hospice and Palliative Care

How Does One Qualify for Hospice Care?

Hospice services involve an individual program of highly-specialized, comprehensive patient care that focuses on a multitude of vital interventions.  Hospice is a multi-disciplined, team-based approach that is readily available for patients who qualify by meeting clearly-defined requirements.

Three primary requisites must be satisfied in order for patients to receive hospice care:  

1)  Patients must be officially certified as terminally ill by the primary-care physician and hospice medical director.  A terminal illness is defined as having a prognosis of 6 months, or less, to live; and a signed certification of terminal illness (CTI) is placed in the patient's file.  That would assume the illness would run its expected course, with the understanding that a doctor is using his or her best professional judgment and knowledge of the, respective, disease. 

In order for an individual to receive hospice services under Medicare, a hospice recipient must be entitled to Part A (hospital insurance) of Medicare.  Aside form Medicare, Medicaid and most private insurance cover hospice. 

A patient's personal case is discussed with a professional team where those team-members determine if a person, legitimately, qualifies for hospice services.  If qualifications are met, it is not uncommon for medical professionals to hold weekly meetings to discuss the patient's status, as well as benefit periods that deal with insurance; and family members and care-takers are kept abreast of the findings from these meetings.  Patients are re-certified when entering the next benefit period, and must continue to meet established criteria to continue to receive hospice services.  Currently, there are two 90-day benefit periods, followed by an unlimited number of 60-day periods.  Terminally-ill Medicare beneficiaries can live more than 120 days and not be concerned about losing coverage for their hospice care. 

Current law states that prior to the 180-day re-certification and prior to each subsequent re-certification, a personal (face-to-face) encounter by a hospice physician or nurse practitioner must take place with hospice patients to determine continued eligibility of hospice care.  

2)  Patients must accept comfort care measures and agree to not pursue curative interventions.  The patient and/or family must be aware of the prognosis and reject restorative measures.  Often, prior to hospice, all curative measures will have been exhausted.  The patient with an illness or disease – whether it might be cancer, COPD, heart problems, or dementia, etc – has to meet a certain level of disability or a certain degree of the illness to qualify for hospice.  Dementia, for example, can progress slowly before an individual reaches the final days of his or her life.  A person can live with dementia for several years before the symptoms reach a point where professional intervention is required and before eligibility for hospice becomes valid.  Hospice does not prolong life, nor does it expedite the end, nor does it focus on treatment – it focuses on the patient and the patient's quality of remaining life. 

3)  Patients must elect to utilize hospice care with a specialized hospice organization.  Specialized hospice organizations have particular expertise regarding various avenues of hospice care.  A specialized program in a hospice organization, for example, might primarily deal with cardiac and pulmonary diseases.  Hospice organizations and their specialized programs benefit patients by delivering added comfort, acknowledging a patient's special circumstances, and educating and supporting families and caregivers.

Hospice services can take place wherever the patient resides, which can be:  any suitable home setting, assisted living facility, skilled nursing and long-term-care facilities, or a hospital.

It is important to understand that hospice care is not, necessarily, always synonymous with imminent end-of-life.  In some cases, patients have improved during hospice care, and have been discharged from hospice services.

After It Is All Said and Done

The focus of hospice care, summed up in one word, would be 'compassion'.  The patient's comfort, dignity, and emotional well-being are of prime importance; and any hospice treatment is as diverse as the person receiving the services.  A patient's loved ones are embraced within hospice services, as well, where emotional support is, always, offered as as vital component.  In fact, professional bereavement services are provided for family members and friends, for many months, after experiencing a loss.  Hospice isn't about dying – it's about living as fully as possible with the time one has remaining. 

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