How to Qualify for Hospice and Begin Comfort-Focused Care

Ana Safarian • November 14, 2024

Life has its end. This is a hard truth that we need to deal with, especially when faced with the heart-wrenching question of whether hospice care might be the right path for ourselves or a loved one. 


For many, this decision doesn’t come easy—it’s filled with questions about timing, eligibility, and what hospice care truly means for the days ahead. You might be wondering, “Are we even ready for this step? Do we even qualify?”


The uncertainty can feel overwhelming, especially when every option, every term, and every decision holds so much weight. But, understanding how to qualify for hospice care can help bring clarity to this emotional crossroads. 

Let's get into it.


What Determines the Need for Hospice Care?


Hospice care is designed for those facing serious health conditions that bring life’s end closer. Eligibility can seem complicated, but it mainly centers on whether a patient’s health needs have shifted from trying to cure the illness to focusing on comfort and quality of life.


Families often find peace in knowing what specific steps are involved in qualifying for hospice, as it helps prepare them for a compassionate approach to care. With clear guidelines and support from healthcare professionals, it becomes easier to decide if hospice is the right path forward.


How to Qualify for Hospice Care: The Basic Requirements


Deciding on hospice care begins with understanding the basic eligibility criteria. Here are the two main factors that lay the foundation for hospice qualification:


Medical Diagnosis of a Life-Limiting Illness


To qualify for hospice, a person usually needs a doctor’s diagnosis confirming a terminal illness like advanced heart disease, cancer, or late-stage dementia. This diagnosis should come with an estimated life expectancy of six months or less if the illness continues on its expected path. Doctors might use specific tools to assess how far the illness has progressed.


Choosing Comfort Care Over Medical Treatments


Hospice care is focused on comfort rather than cures, meaning the person and family agree to shift away from treatments aimed at recovery. Instead, the goal is to manage symptoms and improve quality of life. For those under 21, this agreement might not be necessary to qualify.


Aside from those two, here are additional signs that can further confirm a person’s readiness for this compassionate type of care:


Multiple Hospital or ER Visits in Recent Months


Frequent hospital trips in the last six months can suggest that the illness is getting worse and that the person may need the extra support hospice provides. Regular visits to the hospital often signal that the condition has reached a more advanced stage.


Noticeable Weight Loss and Declining Strength


A decline in weight, especially a loss of 10% or more within six months, is another sign doctors consider. This often includes reduced muscle tone and appetite, which may indicate the person’s condition is worsening and could benefit from hospice care.


Growing Fatigue and Reduced Mobility


Increasing tiredness, muscle weakness, or trouble moving around without help can also signal a decline in health. When energy levels drop and mobility is limited, hospice care can offer the focused support needed to improve comfort in daily life.


What Diagnosis Qualifies for Hospice?

Hospice care is meant for patients with a terminal diagnosis and prognosis of six months or less if the illness follows its expected course. While each condition is different, here are the diagnoses that generally qualify:


Cancer


Patients with advanced, spreading, or progressively worsening cancer may qualify for hospice. Specific signs include a high symptom burden, poor lab results, and signs of metastatic disease. Eligibility also requires a low score on the Palliative Performance Scale (PPS) of less than 70%, and patients typically stop life-extending treatments like chemotherapy or radiation. 


Dementia


Late-stage dementia, defined as stage 7C or beyond on the Functional Assessment Staging (FAST) Scale, is also a common hospice diagnosis. To qualify, the patient must have experienced at least one of the following over the past year: 


  • Aspiration pneumonia
  • Sepsis
  • Severe malnutrition or weight loss
  • Multiple stage 3-4 pressure ulcers
  • Recurrent fever,
  • Dehydration.


Renal Failure


Patients who choose not to undergo dialysis or kidney transplants due to advanced kidney failure may qualify for hospice. Requirements include very low creatinine clearance (under 10, or under 15 for those with diabetes) and high creatinine levels. This may also include symptoms like very low urine output, toxic uremia levels, heart inflammation, or fluid overload that is hard to manage.


Heart Disease


End-stage heart failure, especially New York Heart Association (NYHA) Class IV, where patients experience symptoms like severe breathlessness or chest pain even at rest, can make patients eligible for hospice. Patients must be unable to perform simple activities without breathlessness and should have already received the optimal level of medical care, including medications. Other supporting signs include a low ejection fraction (EF) of under 20% and treatment-resistant heart issues.


HIV/AIDS


Patients with advanced HIV/AIDS who have low CD4 counts (below 25) or high viral loads (over 100,000) may qualify. To meet hospice criteria, these patients should also exhibit severe symptoms like central nervous system lymphoma, significant weight loss, or recurrent infections, and have a low PPS score of 50% or below.


Liver Disease


End-stage liver disease qualifies for hospice if lab results show a prolonged prothrombin time (PT) or high INR and low serum albumin levels. Patients should experience symptoms like unmanageable ascites, recurrent bleeding, liver failure, or advanced malnutrition.


Pulmonary Disease


Patients with advanced lung disease may qualify if they experience extreme shortness of breath even at rest, minimal response to medications, and a reduced ability to function (often limited to bed or chair). Documentation of low blood oxygen levels and high carbon dioxide levels is required, along with signs of disease progression over the last three months.


Neurologic Diseases (ALS, Parkinson’s, MS)


People with advanced neurologic diseases like ALS, Parkinson’s, or multiple sclerosis may qualify if they face severe breathing issues (e.g., breathlessness at rest) and refuse artificial ventilation. Rapid health decline—such as moving from walking independently to being bed-bound—is also considered, along with critical nutritional impairment or recurring complications like aspiration pneumonia.


Stroke or Coma


Patients in a vegetative state with a PPS of less than 40% and a poor nutritional state (10% weight loss over six months, low albumin, or regular aspiration issues) may qualify. For those in a coma, additional criteria include an abnormal brainstem response, lack of verbal response, and no withdrawal from pain on the third day of the coma.


Other Terminal Illnesses


If a patient’s condition doesn’t fit these specific categories but their prognosis is still six months or less, hospice may still be an option. Examples include severe sepsis or life-threatening circulatory issues that would be unlikely to improve.


Medicaid and Medicare Eligibility


To qualify for hospice under Medicaid, a patient typically needs a doctor’s certification of a terminal illness with a life expectancy of six months or less. Patients must also choose comfort-focused hospice care instead of treatments aimed at a cure, although those under 21 may not require this shift in care focus.


Medicare follows similar rules, requiring patients to have Medicare Part A and a terminal diagnosis with a prognosis of six months or less. Medicare also includes coverage for counseling and evaluation services to help patients and families make informed decisions about hospice care.

While Medicaid and Medicare are the main sources of hospice coverage, some private insurance plans may also cover these services. Requirements for private insurance vary, usually including a terminal diagnosis and sometimes requiring patients to stop curative treatments.


Conclusion


Deciding on hospice care for yourself or a loved one can feel overwhelming, especially during a time already filled with heavy emotions. But, having a clear understanding of how to qualify for hospice can help make this choice a little easier, ensuring your loved one receives the right level of care and comfort when it’s needed most. Hospice care is centered on supporting quality of life and prioritizing peace in the final months, offering a compassionate approach tailored to each individual’s journey.



If you’re uncertain about hospice or need guidance, Olympia Hospice is here to help. Reach out to us to learn more about the process, ask questions, and find the support your family deserves at every step.

By Ana Safarian June 3, 2025
Caring for a loved one with a terminal illness often raises difficult questions, including financial ones. Many families want to provide care in a familiar setting, but one of the most common concerns is this: how much does in-home hospice care cost? While this option offers comfort, dignity, and personalized support at home, the price can vary based on location, service needs, and insurance coverage. This guide explains what’s typically included, what to expect out-of-pocket, and how to plan ahead so you can focus on care, not just costs. What Does In-Home Hospice Care Include? In-home hospice care provides a variety of services focused on making your loved one’s final days as comfortable as possible. Common services offered include routine nursing visits, pain and symptom management, home visits from the hospice team , supplies, and other resources. Unlike hospital care, which aims to cure your illness, hospice care shifts the focus to managing your symptoms and providing extra support for everyday tasks. The goal is to alleviate discomfort and provide support with daily living tasks, such as bathing, dressing, and eating. Care is delivered wherever the patient resides, whether in their own home, a relative’s residence, an assisted living facility, or a nursing home. Most services are coordinated through a hospice agency, which works closely with family caregivers to match you with a care plan that meets your loved one’s specific needs. What is the Average Cost of In-Home Hospice Care? Learning the answer to how much does in-home hospice care cost can vary widely depending on factors such as location, provider rates, the patient’s needs, and the level of insurance coverage. While many families don’t pay the full amount due to Medicare , Medicaid, or other private insurance, starting financial planning can reduce the strain of the process of affording end-of-life care. Instead of charging for every individual service, hospice care is billed through a daily rate that covers a full range of services. Based on the benchmarks for hospice care costs set by the Centers for Medicare and Medicaid Services , here’s an in-home hospice cost breakdown for care in the United States using the Medicaid’s FY2024 hospice payment rates as a guide: Nursing Visits Routine home care that includes scheduled nursing visits amounts to $218.61 on average per day for the first 60 days, and $172.57 starting day 61. This covers care coordination, health monitoring, and symptom assessments. Medical Supplies and Equipment Medical supplies and items such as hospital beds, oxygen tanks, and wound care supplies are covered by the hospice agency as part of the daily rate. There are no additional charges under Medicaid or Medicare . Medication Pain and symptom control medications are included in the hospice benefit daily rate under Medicaid/ Medicare . Some small payments may apply under specific private insurance plans but the hospice agency generally covers these medications in full. Emotional and Spiritual Support Chaplain services, social workers, and counseling are part of the hospice team and offer emotional and spiritual care at no additional cost. These services are available to both patients and their families. Does Medicare Cover Hospice at Home? Yes, Medicare provides extensive support for hospice patients who wish to receive home hospice services through the Medicare Hospice Benefit. This benefit covers essential services such as routine nursing visits, medical equipment, pain and symptom control medications, and counseling services for both patients and families at a per-day price. To qualify for hospice care , a patient must be certified by a physician or doctor as having a terminal illness with a prognosis of six months or less to live. Enrollment in a Medicare-approved hospice program and accepting comfort care are also requirements. While most services are fully covered under the benefit, there may be small copayments for medications or other additional services. For individuals without Medicare , Medicaid, and other private insurance plans can also serve as alternatives depending on the provider and policy. Out-of-Pocket Costs and What’s Not Covered While Medicare and Medicaid benefits cover most hospice services, there are some costs that families may need to pay out of pocket. These fall outside standard coverage and can add up, depending on your loved one’s needs, namely: 24/7 Home Health Aides If your loved one requires round-the-clock assistance for everyday tasks, families may need to hire private caregivers outside of their Medicare or Medicaid benefits. Room and Board in a Facility If hospice is provided in an assisted living facility or a nursing home, the hospice benefit may cover care services but not housing or meals. These costs can vary depending on the facility and are typically paid for by the family unless other funding sources are used. Personal Care Services Some non-medical support services, such as housekeeping, laundry, meal preparation, and others, may not be included in the hospice benefit coverage. Private-Pay Options Families who choose a non-network provider may need to pay privately, either per service or through a flat daily rate, and can have significantly increased total expenses without insurance. Is In-Home Hospice More Affordable Than Facility Care? In many cases, in-home hospice care is a more affordable alternative to nursing home care or full-time facility care. Staying at home helps avoid room and board fees associated with care facilities. Families can also control additional expenses based on their loved one’s needs, choosing whether to hire extra help or rely on the core hospice team. However, while home care can reduce some additional costs, it can shift more of the responsibility to families. Assistance tasks like caregiving, supervision, and daily chores may fall to loved ones, which can affect time, stress, and long-term planning. Personalized Support from Olympia Hospice for In-Home Care Decisions At Olympia Hospice Care , we understand that making end-of-life care decisions often comes with the task of asking difficult questions, like how much does in-home hospice care cost. These concerns can feel heavy, but you don’t have to face them alone. Our team is here to provide clarity, empathy, and expert advice every step of the way. We are committed to delivering care that respects your loved one’s comfort, preserves their dignity, and brings peace of mind to those around them. If you’re considering in-home hospice care and have any questions about care plans or symptom management, connect with us today .  We’re here to help you move forward with strength and understanding.
By Ana Safarian June 3, 2025
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