Hospice Appropriateness
Recognize the trajectory, not just the diagnosis.
Eligibility Is Based on Trajectory
Hospice eligibility under Medicare requires a prognosis of six months or less if the illness follows its expected course — but prognosis is a clinical judgment, not a precise prediction. You do not have to prove exactly six months before initiating a hospice evaluation.
Eligibility is based on overall disease trajectory and functional decline — not a single diagnosis or lab value. A hospice referral or evaluation does not equal automatic enrollment; the patient and family retain the decision.
Trajectory Signals
Progressive functional decline despite appropriate treatment. Unintentional weight loss or decreased oral intake in the context of serious illness. Increasing symptom burden that is difficult to manage in the current setting. Recurrent hospitalizations or ED utilization for the same serious illness.
The "surprise question": Would I be surprised if this patient died in the next six months? If the answer is no, a goals-of-care conversation and hospice evaluation are appropriate.
Late Referral Is a Missed Opportunity
Late hospice referral is one of the most common missed opportunities in serious illness care. Earlier referral improves quality of life for patients and reduces caregiver burden.
Hospice eligibility requires recertification — ongoing decline supports continued eligibility. Stabilization may require reassessment of the prognosis.
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