A clear guide to hospice eligibility, what Medicare requires, and the signs that it may be time to ask for an evaluation.

A person typically qualifies for hospice care when two physicians certify they have a serious illness with a life expectancy of six months or less if the disease runs its normal course, and when the focus of care shifts from curing the illness to managing comfort. 

Eligibility is based on overall decline, not age or a single diagnosis. If you are unsure, a hospice nurse can visit, review your medical history, and tell you where things stand. There is no obligation to begin care after an evaluation.

The Two Things That Qualify Someone for Hospice Care

Under the Medicare Hospice Benefit (which Medicaid and most private insurance plans follow), there are two core requirements:

1. A serious, life-limiting illness with a prognosis of six months or less if the illness follows its normal course. Two physicians, usually the patient’s attending physician and the hospice medical director, must certify this in writing.
2. A choice to focus on comfort rather than curative treatment. The patient (or their decision-maker) elects to shift the goal of care toward symptom relief, dignity, and quality of life.

A few important clarifications most families do not know:

• The six-month timeline is a medical estimate, not a deadline. If your loved one lives longer and still meets the criteria, hospice care continues with a physician recertification. Many patients stay in hospice for many months.
• Eligibility is based on overall decline and how the illness is progressing, not on age or a single diagnosis.
• Hospice does not mean stopping all medications or treatments. Therapies that improve comfort, such as pain medications, oxygen, or wound care, continue or begin. What stops are aggressive treatments aimed at curing the illness?

You can read the full criteria your physicians will use on our Hospice Eligibility Guidelines page.

Signs at Home That May Mean It Is Time

Eligibility is a medical decision, but families almost always notice the changes first. The following patterns often prompt a hospice evaluation:

• Repeated hospitalizations or ER visits for the same condition over a short period
• Significant weight loss without trying, or a steady drop in appetite
• More time in bed or in a chair, with less ability to walk, dress, or bathe without help
• Increasing pain, shortness of breath, swelling, or confusion
• Recurring infections such as pneumonia, urinary tract infections, or skin breakdown
• A noticeable decline over the last three to six months, even between hospital visits
• Caregiver exhaustion or the sense that the care needed at home is becoming unsafe

You do not have to see every sign. One or two persistent ones, combined with a serious diagnosis, are reason enough to ask.

For a deeper look at these patterns, see our companion guide on 10 Signs It May Be Time to Consider Hospice Care.

Conditions That Commonly Qualify

Hospice care is not limited to cancer. Any serious illness that is progressing despite treatment may meet criteria. Common qualifying conditions include:

• Cancer with metastatic disease, declining function, or stopped curative treatment
• Heart disease and heart failure, especially with shortness of breath at rest, frequent hospitalizations, or low ejection fraction, not responding to therapy
• Chronic lung disease (COPD) with oxygen dependence, repeated infections, or worsening breathlessness
• Dementia or Alzheimer’s disease at advanced stages, often involving difficulty walking, swallowing problems, weight loss, recurring infections, and limited speech
• Stroke and other neurological conditions, such as ALS or Parkinson’s disease, with a significant decline
• Kidney or liver disease, when a transplant is not an option, and the patient is not pursuing dialysis or curative care
• General decline from a combination of chronic illnesses, where day-to-day function has clearly dropped

If you want a plain-language overview of what hospice does and does not include before going further, our article Hospice Care Explained: What It Is, What It Includes, and What It Does Not is a good companion read.

How the Hospice Eligibility Evaluation Works

If you suspect it may be time, the path forward is simple and unhurried:

1. You make one phone call. A hospice intake nurse will ask a few questions about your loved one’s condition, recent hospital visits, and current symptoms. There is no obligation.
2. A hospice nurse visits, often within 24 hours. The nurse reviews medical records, speaks with the attending physician as needed, examines your loved one, and explains what hospice would and would not do in your specific situation.
3. Two physicians certify eligibility. Typically, the attending physician and the hospice medical director sign off based on clinical findings. You receive a clear explanation of what they observed.
4. The plan of care begins only if you choose to start. Equipment, medications related to the hospice diagnosis, and visits from nurses, aides, social workers, and chaplains are coordinated. Care is available 24/7 from that point forward.

For a step-by-step view of what happens after admission, see Starting Hospice Care.

What to Do This Week If You Are Unsure

You do not need a clear answer before you act. The most useful next step is usually one of these three:

1. Take a short self-assessment. The Hospice Assessment Quiz takes a few minutes and helps you put your observations into words.
2. Request a hospice resource guide. The Hospice Resource Guide explains eligibility, services, and the family experience in one place.
3. Call a hospice team for a no-obligation conversation. A nurse can answer questions over the phone or visit to evaluate in person.

If you would rather think through whether hospice is right before reaching out, our Considering Hospice Care page walks through what to expect from the decision itself.

Frequently Asked Questions

• Does my loved one need a referral from their doctor to be evaluated for hospice? No. A family member, the patient, or a caregiver can call a hospice directly to request an evaluation. The hospice team will coordinate with the attending physician as part of the process.
• Does choosing hospice mean we have to stop seeing our regular doctor? No. Patients can keep their attending physician, who continues to be involved in the plan of care along with the hospice medical director.
• Can my loved one come out of hospice if they improve? Yes. Patients can be discharged from hospice (sometimes called “graduating”) if their condition stabilizes or improves, and they can re-enroll later if they meet criteria again.
• How long does a hospice evaluation take? A first visit usually lasts 45 to 90 minutes, depending on questions and how much medical history needs to be reviewed.
• What if we live in a small community? Will you come to us? Foundations Hospice serves families across Southeast Louisiana, including Livingston Parish, St. Tammany Parish, East Baton Rouge Parish, Ascension Parish, and other surrounding parishes. Care is delivered where patients are most comfortable.
• Where can I learn what specific hospice terms mean? The Glossary of Hospice Terms defines the most common words you will hear during this process, in plain language.

A Gentle Next Step

You do not have to be certain to ask. Most families say they wish they had called sooner, not later.

If you would like a clear answer about whether your loved one qualifies for hospice care, a local nurse can help. Call (225) 209-5629 to speak with a member of the Foundations Hospice team, day or night. You can also schedule a care consult at a time that fits your family.

For a deeper look at what to consider when choosing a hospice provider in our region, our guide on Choosing a Hospice in Baton Rouge: What Families Should Know walks through the questions worth asking.