How To Estimate A Six Month Prognosis For Hospice Eligibility

The following is from Resource (1) below:

How to Estimate a Six-Month Prognosis

A patient is eligible for hospice when 1) he has less than six months to live, and 2) he chooses to forego aggressive curative treatment. While we can help you make that six-month determination ——just call Hospice by the Bay 24/7 for a patient evaluation or consultation —— in general, there are two paths to hospice eligibility:

1. One Major Terminal Diagnosis
Your patient meets CMS’ ‘‘Disease Specific Criteria’’ listed below.

2. Multiple Comorbidities Contributing to Terminal Decline (formerly Debility and Decline)  [Link is to my post of March 28, 2018 on topic] Your patient has multiple signs and symptoms that suggest a terminal course, but does not meet the current ‘‘Disease Specific Criteria’’ for any one diagnosis. Please see pages 1-5 for ‘‘Disease Specific Guidelines.’’ Often a combination of diagnoses is accelerating decline and, if we wait until one diagnosis meets the ‘‘Disease Specific Criteria,’’ the referral may be too late to be of maximum benefit. In these cases, please refer to the ‘‘Decline in Clinical Status Guidelines’’ listed on page 6. [or to my post of March 28, 2018] This list of elements of decline gives examples of how to document your patient’s terminal trajectory. A patient does not have to meet all the criteria on the list. By documenting several areas of decline, you can paint the picture of a poor prognosis.


1. Determining Hospice Eligibility In Terminally Ill Patients Hospice by The Bay – An Affiliate Of USCF Health, Updated 3-2014

2. The Palliative Performance Scale For Determination Of Hospice Eligibility
Posted on March 29, 2018 by Tom Wade MD

3. Instruments For The Assessment Of The Activities Of Daily Living [ADLs]
Posted on March 30, 2018 by Tom Wade MD

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