Hospice Eligibility Criteria: A Family Checklist

This “checklist” is not a test you pass to qualify for hospice — it's a way to organize what you've observed so a physician can make the call. Hospice eligibility is always a physician's judgment that the prognosis is six months or less if the illness runs its normal course. Use the items below to prepare for a hospice evaluation, not to decide eligibility yourself.

First, the one rule that overrides the rest

No family can read a list and conclude a loved one “qualifies.” Two things must be true together, and both are confirmed by a physician: a terminal prognosis of six months or less, and a choice to focus on comfort rather than curing the terminal illness. Here's the full eligibility picture. Everything below simply helps the clinician make that judgment well. To understand the prognosis standard itself, see the 6-month prognosis rule, explained.

What to gather before the evaluation

Bring notes on the following. The more concrete (dates, weights, numbers), the better:

Decline in daily function

• Needs more help with walking, dressing, bathing, eating, or using the toilet than a few months ago
• Spends more of the day in bed or a chair
• New or worsening incontinence

Weight and eating

• Unintended weight loss (note pounds and over what period)
• Eating much less, trouble swallowing, or choking

Medical events and trajectory

• Repeated hospital stays or emergency visits in recent months
• Recurrent infections (pneumonia, urinary, skin)
• Pressure ulcers (bedsores)
• Symptoms that are getting harder to control — pain, breathlessness, agitation
• The illness is progressing despite treatment, or treatment has been stopped

The diagnosis itself

• The main terminal diagnosis and any other serious conditions (heart, lung, kidney, liver, neurological)

Disease-specific signs — a late FAST stage in dementia, breathlessness at rest in COPD or heart failure, stopping dialysis in kidney failure — are commonly cited in Local Coverage Determination guidance and are weighed by the hospice physician. They are supporting evidence, not boxes you tick to qualify.

Why “trajectory” matters more than any single item

A physician certifying hospice is making a judgment about the direction a person is heading, not scoring a snapshot. That is why the most powerful thing a family can bring is a short timeline: what your loved one could do three or six months ago versus now, the dates of recent hospitalizations, the pounds lost and over what period, and whether each crisis ended with a return to the old baseline or a step down to a new, lower one. A single clinic visit often misses this; a person can have a “good day” at exactly the wrong moment. Your written record of steady decline frequently makes the prognosis clearer than any one measurement, and it spares you from trying to recall details under stress during the visit itself.

What the evaluation looks like

Knowing what happens next lowers the anxiety. A hospice nurse or clinician visits — often at home — reviews the medical history and your notes, examines your loved one, and talks with the family about goals and what comfort-focused care would mean. There is no obligation: an evaluation is free and does not commit you to enrolling. If the hospice physician certifies the prognosis and the family chooses comfort care, enrollment can often begin quickly. If not, you can ask again later as the situation changes. For a step-by-step view, see what happens at a hospice evaluation.

How the two-physician certification works

Families are sometimes surprised that more than one doctor is involved. For the first benefit period, the hospice's medical director (or hospice physician) and, typically, the patient's attending physician both certify that the prognosis is six months or less if the illness runs its normal course. After that, the hospice physician recertifies at the start of each benefit period — hospice runs in two 90-day periods followed by unlimited 60-day periods, with recertification each time. Beginning before the third benefit period and before each one after, a hospice doctor or nurse practitioner also conducts a face-to-face encounter (no more than 30 days before the period starts) to confirm continued eligibility. None of this is something the family arranges or scores; it is the clinical machinery behind the scenes. What it means for you is simple: you don't have to “prove” anything yourself — you bring observations, and the physicians make and document the judgment.

The misconception to set aside

The biggest mistake is treating eligibility like a points system: “we checked enough boxes, so we qualify.” It doesn't work that way. A person can meet several items and still not be certified, or have a serious enough overall picture without a long list. The physician integrates everything into one prognosis judgment. So don't conclude your loved one “qualifies” — instead, request an evaluation and let the medical team decide. We are not your medical provider, and this is not medical advice.

Common scenarios families ask about

Real situations rarely match a tidy list, so here is how a few frequent ones tend to play out — keeping in mind that the physician, not this page, makes the determination:

• “They have a serious diagnosis but seem stable.” A diagnosis alone doesn't establish a six-month prognosis. If function, weight, and symptoms are holding steady, a physician may judge it too early — and you can ask again as things change.
• “They're declining fast but don't have a single 'terminal' label.” General, documented decline — weight loss, repeated infections, loss of function across several conditions — can support eligibility even without one headline diagnosis. The overall picture is what counts.
• “The doctor hasn't brought up hospice.” Many physicians wait for families to raise it. You can start the conversation or contact a hospice directly for an evaluation; you don't need to wait to be offered it.
• “We tried before and were told no.” Eligibility is reassessed over time. A “not yet” earlier does not prevent a later evaluation if the decline continues.

Frequently asked questions

Can I tell from this list whether my loved one qualifies?

No. The list helps you prepare and organize observations, but a physician makes the prognosis judgment. The right step is to request an evaluation, not to score yourself.

Do we need a doctor's referral to get an evaluation?

No. You can ask the treating doctor for a referral or contact a hospice directly. You do not need a doctor's permission to ask a hospice to assess your loved one.

Is the evaluation a commitment to enroll?

No. The evaluation is free and carries no obligation. You can decline to enroll, and you can request another evaluation later if the situation changes.

What if the hospice says “not yet”?

That can happen if the physician doesn't yet judge the prognosis to be six months or less. Decline is reassessed over time, so you can ask again as things change — and in the meantime review signs it may be time to consider hospice.

What to do next

If several items above describe your loved one, the right step is to request a free hospice evaluation. You can ask the treating doctor for a referral or contact a hospice directly — you do not need a doctor's permission to ask a hospice to assess your loved one. Bring your notes; they often make the trend of decline visible in a way a single visit cannot.

When you're ready, compare Medicare-certified hospices near you. You may also want to read signs it may be time to consider hospice and what happens at a hospice evaluation.