Hospice Eligibility Guidelines
Hospice Eligibility Guidelines Families Should Know
Making decisions about end-of-life care can feel overwhelming. The last thing you want to think about is losing a loved one, and considering many of these decisions means coming to terms with a loss. It’s no surprise that families tend to struggle during this time, especially when trying to understand hospice eligibility. Thankfully, Agape Hospice & Palliative Care can help you cut through the misinformation. We’re here to ensure you’re aware of the specific hospice qualifications and when your loved one could benefit from these services. Learn more about who is eligible for hospice.

General Hospice Eligibility Criteria
To qualify for hospice care, patients must meet certain medical criteria. These are established by Medicare and followed by most insurance providers. Firstly, your loved one’s physician will need to certify that they have a life expectancy of six months or less if the illness runs its normal course. Their physician and hospice medical director will both document this prognosis. In addition to the recommendation of a physician, patients should also meet these requirements for hospice eligibility:
- Comfort Over Cure—Folks in hospice have chosen to focus on comfort over curative treatment. This doesn’t mean stopping all medical care, but it does mean that treatments are designed to improve quality of life rather than trying to “solve” the underlying condition.
- Functional Decline—If your loved one is experiencing noticeable signs of physical decline, they may meet the hospice qualifications. Significant weight loss, lack of mobility, more frequent hospitalization, and decreased ability to do daily activities should all indicate overall functional decline.
Medical Conditions That Typically Qualify
Many different medical conditions can make someone eligible for hospice care. The key factor is not the specific diagnosis, but rather the stage and progression of the illness. Here are some common conditions that could increase your loved one’s hospice care eligibility:
Heart Disease
Advanced heart disease affects millions of Americans and can qualify for hospice care when certain conditions are present. For example, if your loved one has been diagnosed with advanced coronary artery disease or severe heart valve problems, they benefit from hospice care. Other factors that could increase the need for hospice include:
- Heart failure
- Repeated hospitalization
- Severe chest pain
- Fluid retention
- Significant symptoms despite proper management strategies
Respiratory Conditions
Chronic lung conditions can lead to a need for hospice care when a patient’s quality of life starts to decline. Increased oxygen requirements, worsening lung function tests, and inability to go about daily activities could all make hospice care the best option. Many folks who choose hospice for lung disease also have these indicators:
- Chronic obstructive pulmonary disease (COPD) with severe symptoms
- Pulmonary fibrosis with progressive decline
- Advanced lung disease requiring continuous oxygen
- Frequent respiratory infections or hospitalizations
- Severe shortness of breath with minimal activity
Kidney Disease
End-stage kidney disease can qualify patients for hospice care, particularly when dialysis is no longer effective or desired. Some patients choose to stop dialysis and enter hospice care, while others may qualify while still receiving dialysis if their overall condition continues to decline. If your loved one’s quality of life has deteriorated substantially or other organs have started failing as well, it’s likely time to start hospice care.

Neurological Conditions
Progressive neurological diseases often qualify for hospice care as they advance. These conditions typically qualify when patients experience severe cognitive decline, difficulty swallowing, frequent infections, or significant weight loss. Talk to your loved one’s physician about the possibility of hospice after these diagnoses:
- Alzheimer’s disease and other forms of dementia
- Amyotrophic lateral sclerosis (ALS)
- Multiple sclerosis with significant progression
- Huntington’s disease
- Stroke
Liver Disease
Advanced liver disease, both alcoholic and non-alcoholic, can qualify patients for hospice care when:
- Cirrhosis has progressed to end-stage
- Liver function tests show severe issues
- Complications like bleeding or fluid retention occur
- Hepatic encephalopathy develops
- Liver transplant is not an option
Terminal Cancer
Cancer remains one of the most common reasons people enter hospice care. Specific types of cancer that frequently qualify include advanced lung cancer, pancreatic cancer, liver cancer, and brain tumors. However, any cancer type can qualify if it meets the progression criteria. Eligibility factors include:
- Metastatic cancer that has spread to other parts of the body
- Cancer that no longer responds to treatment
- Rapid progression despite aggressive treatment
- Significant decline in overall function
- Complications from cancer treatment
Making Informed Decisions About Hospice Care
Seeing your loved one lose their everyday abilities is undeniably difficult. While making the decision to start hospice care is never easy, it’s often necessary to prolong your loved one’s quality of life and increase their comfort. While there’s no single “hospice eligibility checklist,” when you know the general qualifications, you can make an informed decision about starting hospice. When that time comes, Agape Hospice & Palliative Care is here for you. We’re honored to serve Los Angeles and Orange Counties with compassionate, comprehensive care. Contact us today to learn more.