Educational Resource
When Is It Time for Hospice?
Knowing when to consider hospice care is one of the most important — and most difficult — decisions a family can face. This guide outlines the common indicators and disease-specific criteria that healthcare professionals use to assess hospice eligibility.
If you recognize these signs in your loved one, it does not necessarily mean hospice is the only option — but it may be time to have a conversation with their physician and our care team.
General Criteria
Common Indicators for Hospice
While every patient's situation is unique, the following indicators are commonly observed in individuals who may benefit from hospice care. These signs suggest that the disease is progressing and that comfort-focused care may provide the greatest quality of life.
Functional Decline
A noticeable and ongoing decrease in the ability to perform everyday tasks and activities.
Unintentional Weight Loss
Significant, unexplained weight loss over a period of weeks or months despite adequate nutrition.
Multiple Co-Morbidities
The presence of two or more chronic conditions that together reduce overall health and quality of life.
Decreasing Serum Albumin
Low albumin levels in the blood, often indicating malnutrition and declining organ function.
Dependence in Activities of Daily Living
Needing assistance with most ADLs — bathing, dressing, eating, toileting, and transferring.
Karnofsky or Palliative Performance Scale Below 50%
A clinical measure indicating the patient requires considerable assistance and frequent medical care.
Qualifying Conditions
Common Hospice Diagnoses
Hospice care is available for patients with a wide range of terminal diagnoses. Below are the most common conditions, with detailed disease-specific indicators further down the page.
Clinical Reference
Disease-Specific Hospice Indicators
Each terminal illness has specific clinical indicators that help physicians and care teams determine when hospice may be appropriate. The following criteria are used as guidelines — not absolute requirements. A patient does not need to meet every indicator to qualify.
Cancer
- Progression from an earlier stage of the disease
- Patient chooses to discontinue curative treatment
- Declining functional status despite treatment
Renal (Kidney) Disease
- Patient is not seeking or has discontinued dialysis
- Creatinine clearance less than 10 cc/min (less than 15 cc/min with diabetes)
- Urine output less than 400 cc/day
- Signs of uremia — confusion, nausea, vomiting, pericarditis, restlessness
- Serum creatinine greater than 8.0 mg/dl (greater than 6.0 mg/dl with diabetes)
Heart Disease
- Symptomatic despite optimal treatment with diuretics and vasodilators
- Recurrent congestive heart failure (CHF)
- NYHA Class III or IV heart failure
- Ejection fraction less than 20%
- History of cardiac arrest
HIV/AIDS
- CD4+ count less than 25 cells/mcl
- Viral load greater than 100,000/ml
- Resistance to drug therapy or wasting syndrome
- PML, MAC bacteremia, or CNS lymphoma
- Karnofsky or Palliative Performance Scale less than 70%
ALS & Parkinson's Disease
- Wheelchair bound or bed bound
- Unintelligible speech or difficulty swallowing
- Nutritional status declining
- Dyspnea at rest or requires supplemental oxygen
- Stage 3–4 pressure ulcers
Pulmonary (Lung) Disease
- Dyspnea (shortness of breath) at rest
- FEV1 less than 30% after bronchodilators
- Recurrent pulmonary infections
- Cor pulmonale or right heart failure
- pO2 less than 55 mmHg or O2 saturation less than 88% on supplemental oxygen
- Persistent resting tachycardia
Liver Disease
- Patient is not a candidate for a liver transplant
- Prothrombin time (PTT) greater than 5 seconds over control
- Serum albumin less than 2.5 gm/dl
- Ascites refractory to treatment
- Hepatic encephalopathy
- Variceal bleeding, malnutrition, or Hepatitis B or C
Dementia & Alzheimer's
- FAST score greater than 7 (Functional Assessment Staging)
- Ability to speak limited to fewer than 6 words
- Weight loss and inability to maintain nutrition
- Unable to ambulate without assistance
- Urinary and fecal incontinence
- Recurrent infections (UTI, pneumonia, sepsis)
Stroke
- Severe dysphagia (difficulty swallowing) without artificial nutrition or hydration
- Dependence in all activities of daily living (ADLs)
- Post-stroke dementia
- Urinary and fecal incontinence
- Absent or minimal verbal response
Important: These indicators are clinical guidelines used by healthcare professionals. They are not a self-diagnosis tool. If you believe your loved one may benefit from hospice care, please speak with their physician or contact our care team for a free, no-obligation consultation.
Common Questions
Understanding Hospice Eligibility
What are the general signs that someone may be eligible for hospice care?
Common signs include a noticeable decline in the ability to perform daily activities, unintentional weight loss, increasing dependence on others for basic needs like bathing and eating, frequent hospitalizations, and a physician's assessment that the condition is progressing despite treatment. If you're noticing these changes, it may be time to have a conversation about hospice.
Does a hospice diagnosis mean giving up hope?
Not at all. Hospice is about shifting the focus from curative treatment to comfort, quality of life, and dignity. Many families find that hospice actually brings more peace, more presence, and more meaningful time together. It's one of the most loving decisions a family can make.
Who determines if a patient qualifies for hospice?
A physician must certify that the patient has a terminal illness with a prognosis of six months or less if the disease follows its expected course. The hospice medical director and the patient's attending physician work together to make this determination. Ability's care team can help facilitate this process.
Can a patient leave hospice if their condition improves?
Yes. Hospice is not a one-way door. If a patient's condition stabilizes or improves, they can be discharged from hospice and return to curative treatment. They can also re-enroll in hospice later if needed. There is no penalty for leaving hospice.
Is hospice care covered by insurance?
Yes. Medicare Part A covers hospice care at 100% for eligible patients, including medications related to the terminal diagnosis, medical equipment, nursing visits, aide services, and bereavement support. Medicaid and most private insurance plans also cover hospice. Many families pay nothing out of pocket.
How do I start the conversation about hospice with my family?
Start by focusing on comfort and quality of life rather than the word "hospice." You might say, "I want to make sure Mom is as comfortable as possible." Our care advisors at Ability are trained to help families navigate this conversation with sensitivity and compassion. Call us anytime at (385) 287-1311.
Related Resources
Learn More About Hospice Care
Not Sure If It's Time for Hospice?
Call for a free, no-obligation consultation. Our compassionate care team is ready to listen, answer your questions, and help your family find the right support.