Eligibility
Need Help Determining? Card
Service
Home Health
Many children and adults qualify for, and would benefit from, receiving home health care services but don’t know they qualify. If you or your children have any condition that may cause difficulties in daily activities, give us a call. We can provide a free consultation to direct you to services and financial assistance that may help.
You may qualify for home health care if you:
1. Are under the care of a doctor
2. Need one of the following:
a. Skilled Nursing
b. Physical Therapy
c. Occupational Therapy
d. Speech Therapy
3. Are home bound (includes nursing homes and long-term care facilities). Indications that you may be home bound includes use of a cane, walker, wheelchair or needing assistance to leave your home.
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Hospice
Enrolling in Hospice may help you after an end-of-life diagnosis. We can not only help with management of your health condition, but also with counseling and resources and social services needed during your transition. Your family and loved ones will also receive support services when you enroll in hospice; even after you have moved on.
You may qualify for hospice if you have any of the following:
1. A terminal illness with a life expectancy of six (6) months or less (if the disease runs its normal course).
2. Documented evidence of rapid decline in clinical status.
3. A specific qualifying medical condition and symptoms (see below).
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Hospice Eligibility by Medical Diagnosis
General Information
Some patients may not meet the guidelines of a primary diagnosis, yet still have a life expectancy of six months or less.
Determining a primary hospice diagnosis can be challenging when a patient has some, but not all, of the clinical indicators of a specific disease or condition. Other clinical variables not on the list may support the six-month or less life expectancy. These should be documented in the clinical record.
Several clinical signs often support hospice eligibility in combination with another primary diagnosis.
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ALS / Lou Gehrig’s disease
Alzheimer’s Disease or Dementia
Amputation
Birth Defects
Cancer
Cerebral Palsy
Diabetes
Heart Disease
HIV/AIDS
Huntington’s Disease
Huntington’s DiseaseShort Description
Kidney Disease
Liver Disease
Lung Disease
Multiple Sclerosis
Parkinson’s Disease
Stroke or Coma
Traumatic Injury
Other
Home Health
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Hospice
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Non-Disease Specific Baseline Guidelines
A. Physiologic impairment of functional status as demonstrated by: Palliative Performance Score (PPS) < 70% (note that two of the disease specific guidelines (HIV, Stroke& Coma) establish a lower qualifying PPS.
B. Dependence on assistance for two or more activities of daily living (ADLs):
- Ambulation;
- Continence;
- Transfer;
- Dressing;
- Feeding;
- Bathing
C. Co-Morbidities—although not the primary hospice diagnosis, the presence of diseases such as the following, the severity of which is likely to contribute to a life expectancy of six months or less, should be considered in determining hospice eligibility:
- COPD
- CHF
- Ischemic heart disease
- Diabetes mellitus
- Neurologic disease
- Renal Failure
- Liver Disease
- Neoplasia
- AIDS/HIV
- Dementia
- Refractory severe autoimmune disease (Lupus, RA)
Progression of disease may be supported by:
Significant decline in clinical status
- Recurrent infections (e.g. pneumonia, sepsis, pyelonephritis)
- Progressive inanition o weight loss (≥10% body weight in prior 6 months)
- ↓ anthropomorphic measurements (e.g., mid-arm circ, abdominal girth)
- Observation of ill-fitting clothes, ↓in skin turgor, ↑ skin folds
- ↓ serum albumin or cholesterol o Dysphagia leading to recurrent aspiration and/or inadequate oral intake
Worsening symptoms
- Pain requiring increasing doses of major analgesics more than briefly; nausea/vomiting, poorly responsive to treatment; diarrhea, intractable; dyspnea with increasing respiratory rate; cough, intractable
Signs
- Hypotension (SBP <90mmHg or postural hypotension); edema; ascites; pleural/pericardial effusion; venous, arterial or lymphatic obstruction due to local progression or metastatic disease; weakness; change in level of consciousness, etc.
Laboratory results
- Decreasing albumin; progressively decreasing/increasing serum sodium; increasing serum potassium; increasing calcium, creatinine or liver function studies; increasing pC02, decreasing p02, or decreasing Sa02; increasing tumor markers, etc.
Change in Functional status
- Decline in PPS score; progressive decline in Functional Assessment Staging (FAST) for dementia (from 7A on the FAST); progressive stage 3-4 pressure ulcers; history of increasing ER visits, hospitalizations or physician visits related to the hospice primary diagnosis prior to election of hospice.
Debility may not be listed as a primary diagnosis, but is an accepted co-morbid condition when another primary diagnosis does not in itself meet the guidelines.
ALS / Lou Gehrig’s disease
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Alzheimer’s Disease or Dementia
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Amputation
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Birth Defects
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Cancer
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Cerebral Palsy
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Diabetes
Dolore aliquam accusamus et cum, vel eu graece antiopam constituto. Omnes regione definiebas ea mel, sed rebum malorum ut. Has ne quod ludus, ea vis wisi constituam. Cu nam affert laoreet pertinax. Recteque inciderint id mel, doctus vulputate te vis, his in erat option detraxit. Probo interpretaris ei his, quo ad vidit prima, et decore debitis appellantur sed.
Heart Disease
Dolore aliquam accusamus et cum, vel eu graece antiopam constituto. Omnes regione definiebas ea mel, sed rebum malorum ut. Has ne quod ludus, ea vis wisi constituam. Cu nam affert laoreet pertinax. Recteque inciderint id mel, doctus vulputate te vis, his in erat option detraxit. Probo interpretaris ei his, quo ad vidit prima, et decore debitis appellantur sed.
HIV/AIDS
Dolore aliquam accusamus et cum, vel eu graece antiopam constituto. Omnes regione definiebas ea mel, sed rebum malorum ut. Has ne quod ludus, ea vis wisi constituam. Cu nam affert laoreet pertinax. Recteque inciderint id mel, doctus vulputate te vis, his in erat option detraxit. Probo interpretaris ei his, quo ad vidit prima, et decore debitis appellantur sed.
Huntington’s Disease
Dolore aliquam accusamus et cum, vel eu graece antiopam constituto. Omnes regione definiebas ea mel, sed rebum malorum ut. Has ne quod ludus, ea vis wisi constituam. Cu nam affert laoreet pertinax. Recteque inciderint id mel, doctus vulputate te vis, his in erat option detraxit. Probo interpretaris ei his, quo ad vidit prima, et decore debitis appellantur sed.
Kidney Disease
Dolore aliquam accusamus et cum, vel eu graece antiopam constituto. Omnes regione definiebas ea mel, sed rebum malorum ut. Has ne quod ludus, ea vis wisi constituam. Cu nam affert laoreet pertinax. Recteque inciderint id mel, doctus vulputate te vis, his in erat option detraxit. Probo interpretaris ei his, quo ad vidit prima, et decore debitis appellantur sed.
Liver Disease
Dolore aliquam accusamus et cum, vel eu graece antiopam constituto. Omnes regione definiebas ea mel, sed rebum malorum ut. Has ne quod ludus, ea vis wisi constituam. Cu nam affert laoreet pertinax. Recteque inciderint id mel, doctus vulputate te vis, his in erat option detraxit. Probo interpretaris ei his, quo ad vidit prima, et decore debitis appellantur sed.
Lung Disease
Dolore aliquam accusamus et cum, vel eu graece antiopam constituto. Omnes regione definiebas ea mel, sed rebum malorum ut. Has ne quod ludus, ea vis wisi constituam. Cu nam affert laoreet pertinax. Recteque inciderint id mel, doctus vulputate te vis, his in erat option detraxit. Probo interpretaris ei his, quo ad vidit prima, et decore debitis appellantur sed.
Multiple Sclerosis
Dolore aliquam accusamus et cum, vel eu graece antiopam constituto. Omnes regione definiebas ea mel, sed rebum malorum ut. Has ne quod ludus, ea vis wisi constituam. Cu nam affert laoreet pertinax. Recteque inciderint id mel, doctus vulputate te vis, his in erat option detraxit. Probo interpretaris ei his, quo ad vidit prima, et decore debitis appellantur sed.
Parkinson’s Disease
Dolore aliquam accusamus et cum, vel eu graece antiopam constituto. Omnes regione definiebas ea mel, sed rebum malorum ut. Has ne quod ludus, ea vis wisi constituam. Cu nam affert laoreet pertinax. Recteque inciderint id mel, doctus vulputate te vis, his in erat option detraxit. Probo interpretaris ei his, quo ad vidit prima, et decore debitis appellantur sed.
Stroke or Coma
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Traumatic Injury
Dolore aliquam accusamus et cum, vel eu graece antiopam constituto. Omnes regione definiebas ea mel, sed rebum malorum ut. Has ne quod ludus, ea vis wisi constituam. Cu nam affert laoreet pertinax. Recteque inciderint id mel, doctus vulputate te vis, his in erat option detraxit. Probo interpretaris ei his, quo ad vidit prima, et decore debitis appellantur sed.
Other
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