1. The patient has a progressive life-limiting disease with an estimated life expectancy of six (6) months or less if the disease follows its normal course.
2. The patient has an attending physician who is willing to certify the limited life expectancy of the patient, to take care of the medical needs of the patient and to work with the Hospice team. If the attending physician or designee does not have admitting privileges at an affiliated hospital, arrangements must be made for coverage, should the patient require hospitalization related to the terminal illness.
3. The patient has a family member or other appropriate person willing to assume responsibility for decision making should the patient lack capacity.
4. A mutually agreeable plan of care for a safe environment is developed with the patient and alternate decision maker.
5. It is the responsibility of the patient/family unit to meet the standard of need for caregiving as articulated in the Hospice Admissions Criteria and as evaluated by qualified professionals from time to time. Medicare and New York State regulations assert that “Hospices are not expected to provide the types of services associated with primary care-givers but rather they are expected to supplement the care provided by family members and others.” Hospice reserves the right to determine the extent of need for such supplemental care.
6. The patient and primary care person are informed of the diagnosis and prognosis, as culturally appropriate, and give consent for Hospice care.
7. The patient and attending physician agree that the goal of treatment under Hospice care is palliative in nature, addressing pain and symptom management and is not intended to be curative, life-prolonging or remission-inducing.
8. The patient resides within the service area of the Hospice program.
9. No person is discriminated against for the purposes of admission or provision of service based upon his/her race, color, creed, national origin, age, gender, sexual orientation, physical or mental disability, ability to pay, or the presence or absence of advance medical directives in so far as the directives are consistent with the Hospice Guidelines.
G:/Clinical/forms/Admission Criteria 1/11, 2/12