Eligibility Guidelines

What Is Hospice Care?

Hospice care is specialized medical care focused on comfort, dignity, and quality of life for individuals facing a life-limiting illness. Care is provided wherever the patient calls home, including a private residence, nursing facility, or assisted living community.

Hospice care supports both the patient and the family through medical care, emotional support, and guidance during this time.

General Hospice Eligibility Guidelines

A patient may be eligible for hospice care when all of the following apply:

• A physician has determined the patient has a life-limiting illness.
  This means the patient has a serious condition where the focus is shifting from cure to comfort. The hospice team can work with the patient’s attending physician and specialists to review recent medical records, symptoms, and overall decline.
• The illness is expected to have a prognosis of six months or less if it follows its normal course.
  This is a medical estimate based on how the condition is progressing. It is not a “deadline.” If a patient lives longer than six months and still meets eligibility guidelines, hospice care can continue as long as the physician recertifies the need.
• The patient and family choose comfort-focused care rather than curative treatment.
  Hospice care focuses on relief from pain and symptoms, emotional and spiritual support, and helping patients live as fully and comfortably as possible. Some treatments may still be appropriate if they improve comfort, such as medications, oxygen, or therapies aimed at symptom relief.

Hospice eligibility is based on medical criteria and overall decline, not age, diagnosis alone, or insurance type. If you are unsure whether a loved one qualifies, a hospice evaluation can help clarify options and next steps.

Hospice Eligibility and Medicare Coverage

Hospice care is covered by Medicare Part A, as well as Medicaid and most private insurance plans.

To qualify for Medicare-covered hospice care:

• Two physicians must certify the patient meets hospice eligibility guidelines
• One physician is typically the patient’s attending physician
• The other is the hospice medical director

Coverage includes:

• Physician-directed care
• Nursing visits and on-call support
• Medications related to the hospice diagnosis
• Medical equipment and supplies
• Social work, spiritual support, and bereavement care

There is no deductible for hospice services under Medicare Part A.

Common Conditions That May Qualify for Hospice

Hospice eligibility is based on overall health decline, how a condition is progressing, and how much support you need day to day, not just a diagnosis alone. Many people qualify when a serious illness is causing increasing symptoms, frequent hospital visits, weight loss, weakness, or a noticeable drop in function.
Common diagnoses that may qualify include:

• Cancer
• Heart disease or heart failure
• Chronic lung disease
• Dementia or Alzheimer’s disease
• Stroke or neurological conditions
• Kidney or liver disease
• General decline with multiple chronic conditions

Meeting hospice eligibility guidelines does not mean giving up care. It means shifting the focus to comfort, symptom management, and emotional and spiritual support, so you and your family feel more supported at home or wherever care is needed.

Signs It May Be Time to Ask About Hospice

Families often reach out when they notice changes such as:

• Frequent hospitalizations or emergency room visits
• Increased pain, shortness of breath, or discomfort
• Declining ability to perform daily activities
• Significant weight loss or reduced appetite
• Increased fatigue or sleeping most of the day
• Care needs becoming difficult to manage at home

If you are noticing these changes, a hospice evaluation can help clarify options.

What if You Are Unsure About Eligibility?

You do not need to be certain to ask for help. Hospice evaluations are free, and there is no obligation to begin services.

A hospice nurse can:

• Review medical history
• Communicate with physicians
• Explain whether hospice care is appropriate now or later

Many families say they wish they had asked sooner.

How Foundations Hospice Helps With Eligibility

Our team at Foundations Hospice take the time to guide families through hospice eligibility guidelines with clarity and compassion. Our locally owned team works closely with physicians and caregivers to ensure every patient receives personalized care aligned with their wishes.

We serve families across Ascension Parish, Livingston Parish, Jefferson Parish, Orleans Parish, St. Charles Parish, and surrounding Louisiana communities.