Hospice Eligibility Guidelines

Does My Loved One Qualify for Hospice Care?

This is one of the first questions families ask, and one of the most important. Understanding hospice eligibility helps you know whether now is the right time to reach out, and what to expect when you do.

If you already believe your loved one may qualify, you don’t need to wait. Our team will walk through their situation with you directly.

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The General Eligibility Criteria

To qualify for hospice care, two conditions must be met:

A terminal diagnosis. A physician must certify that your loved one has a life-limiting illness and, if the illness follows its natural course, a prognosis of six months or less.
A shift in the goals of care. Your loved one or their authorized decision-maker must agree to focus care on comfort, quality of life, and symptom management rather than curative treatment.

Meeting these two criteria is what opens the door to hospice care and all of the services that come with it.

Conditions That Commonly Qualify

Hospice is appropriate for a wide range of terminal diagnoses. Common qualifying conditions include:

Cancer
Heart disease or congestive heart failure (CHF)
Chronic obstructive pulmonary disease (COPD)
Dementia or Alzheimer’s disease
Kidney failure or end-stage renal disease
Liver disease or end-stage liver failure
Stroke or neurological disease
ALS (Amyotrophic Lateral Sclerosis)
HIV/AIDS
Parkinson’s disease
Failure to thrive

This list is not exhaustive. If your loved one has a serious illness not listed here, contact our team. Eligibility is determined by clinical condition and prognosis, not diagnosis alone.

Signs That Hospice May Be Appropriate Now

Beyond a formal diagnosis, there are clinical and functional signs that often indicate a patient may be ready for hospice care:

Frequent hospitalizations or emergency room visits with little to no improvement
Significant unintentional weight loss over the past several months
Increasing difficulty with basic daily activities: eating, bathing, mobility
Pain, breathlessness, or other symptoms that are becoming harder to manage
Repeated infections or a pattern of declining overall health
A clearly expressed wish to remain at home and focus on comfort

If several of these apply to your loved one, it is worth having a conversation with their physician, and with us.

Who Makes the Eligibility Determination?

A physician, either your loved one’s attending physician or a hospice physician, must certify that the patient meets hospice eligibility criteria. This certification is required to begin care and is renewed at regular intervals.

Families do not need to obtain this certification themselves. When you contact Golden Rule Hospice, our team works directly with the attending physician to verify eligibility and complete all required documentation on your behalf.

What If the Prognosis Is Uncertain?

A six-month prognosis does not mean your loved one will pass away within six months. It means that if the illness follows its expected course, the physician believes life expectancy to be six months or less.

Patients who live longer than six months can and do continue to receive hospice care, as long as a physician recertifies that they continue to meet eligibility criteria. Many patients remain enrolled in hospice for a year or more.

Patients can also be discharged from hospice if their condition stabilizes or improves, and re-enroll later if their health declines again.

What Eligibility Means for Coverage

When a patient is certified as hospice-eligible, the Medicare Hospice Benefit covers all related services at no out-of-pocket cost. This includes:

Nursing visits and physician oversight
Certified nursing aide personal care
Medications related to the hospice diagnosis
Medical equipment and supplies delivered to the home
Social work, chaplaincy, and bereavement support

Medicaid and most private insurance plans also cover hospice care for eligible patients.

Not Sure If Your Loved One Qualifies?

You don’t need to know the answer before you call. Our care team will listen to your loved one’s situation, help you understand whether they are likely to qualify, and guide you through next steps, at no cost and with no obligation.

Many families discover their loved one has been eligible longer than they realized. The sooner care begins, the more time your loved one has to benefit from it.

Frequently Asked Questions

Does my loved one have to stop all treatment to qualify?

Not necessarily. Patients must agree to focus care on comfort rather than curative treatment for the hospice diagnosis. However, treatment for unrelated conditions can often continue. Your care team will clarify what applies to your loved one’s specific situation.

Can a patient qualify without a cancer diagnosis?

Yes. Hospice is appropriate for any terminal illness: heart disease, COPD, dementia, kidney failure, and many others. Eligibility is based on prognosis and goals of care, not the specific diagnosis.

Can our family reach out without a doctor’s referral?

Yes. You can contact Golden Rule Hospice directly. We will work with your loved one’s physician on the certification process. A referral is not required to start the conversation. Contact us anytime

What if the doctor hasn’t brought up hospice yet?

Physicians don’t always raise hospice proactively. If you believe your loved one may benefit, you have every right to ask their doctor or to call us first. We can help you understand whether now is the right time and how to approach that conversation.

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Carla R.

Golden Rule had proven to be the top tier , when it come to care and resources, Minnie Baker, Shamille, and Liz have always been there for my client. Doesn't matter the need they are always a phone call away to assist in directing the care and resources needed. I'm so thankful we chose them. My client absolutely loves Ms Minnie, and Shamille. Thanks for all you do, your the best.

Heaven H.

We are very grateful to have found golden rule hospice. We have been working with Vivian who treats my Dad with dignity and respect, and it gives our family so much peace knowing he is in such capable and caring hands. Her work ethic is exceptional, and the level of dedication she shows is something we deeply appreciate. She goes above and beyond, and we are truly blessed to have her. His Nurse Muriel is also wonderful, and does a great job helping our family understand my dad’s needs and care plan. We truly appreciate how clearly she explains his needs and keeps us informed.

Mary

Thank you Golden Rule for being an outstanding hospice care service! When my hubby was diagnosed with a debilitating terminal illness, we secured the name of the hospice care (Golden Rule) that my friend used for her mother. She was very pleased with them, as are we. Our GR hospice team consists of Nurse Cheryl, CNA Andre, Chaplain Stanley, and Social Worker Heather. Nurse Cheryl does a thorough weekly assessment of hubby's condition, orders equipment and prescriptions and always follows up to be sure they have been delivered. She returns our calls promptly. Above all, she is very loving and caring. My husband calls Andre the gentle giant! Andre helps with shower care and my husband is very comfortable with him. Andre works closely with Cheryl and is extremely knowledgeable. We are so thankful this amazing man is on our team. Chaplain Stanley's soft demeanor and interesting stories puts my husband at ease and puts a smile on his face. We both enjoy when he brings his guitar and sings for us. SW Heather continues to be a great wealth of information for us and just a phone call away. We are very thankful for Golden Rule Hospice care during this difficult time in our lives.

kristen L.

Kathy Hazellief is truly wonderful with our hospice residents at Dahlonega Assisted Living and Memory Care. Every time she comes in you can see how much she genuinely cares — she takes her time, speaks gently, and makes sure our residents feel comfortable, calm, and respected. She’s also very supportive to families and staff, explaining things in a way everyone understands and never making anyone feel rushed. Honestly she’s our favorite and does the best by far. We are so thankful for the compassion and kindness she shows because she really makes a hard time a little easier for our residents, their families, and our team.

Alisa S.

Golden rule has provided exceptional care for my mom who is under their care. The nurse, Chris, has been exceptional. The CNA, Kathy, has been exceptional as well. We are extremely happy with their services and would highly recommend them to anyone.

Carla R.

I absolutely love the services that are provided ( Nurse ) Shamille, (CNA) Minnie B. are an awesome team providing care for my client that is 98 yrs. young like a family member. E all look forward to their visits wkly . If I could award this star team personally I would, for such excellent work jobs well done. Thank you for all that you have done and continue to do ❣️❣️❣️ it definitely takes a village and special angels to do what is needed to keep clients comfortable and happy . Carla Rogers

Trish T.

Shamille and Vivian have been so wonderful to my dad Robert Butler. They are kind, caring and respectful of my dad. They have also been very kind to me and my sisters as we go thru this end of life journey for my dad Obviously Golden Rule Hospice is an excellent hospice based on these two women.

Stefanie B.

My father was taken care of 3 years ago by Golden Rule and he changed his mind and "graduated". He just turned 97 and after celebrating, he declined rapidly. Fortunately, I knew who to call. Golden Rule was fabulous then and fabulous now. I requested the same nurse, Shamille, and she is as loving and attentive as she was previously. I thoroughly trust her and she always responds to my calls and questions. By the time hospice came on the scene my father was bedridden. The CNA, Vivian, came to bathe him and watching her with him made me cry. She knew exactly how to maneuver him and she made sure his bedding was clean as well. She shaved him and brushed his teeth. He was so happy and said "I feel so good now." She is exquisite in her care. He is in his very last days and she came by just to make sure he was ok and that I was ok. Everyone there I have interacted with (both times) is caring, professional and bring light into what could be a dark time. Elizabeth, the social worker, checks on us regularly and makes sure all the paperwork is in order. Thank you Golden Rule.

Helen H.

Vivian (our CNA) has been very amazing! She takes good care of my dad & helps us any way she can making it easier on my family. We’re so grateful for her as a family. Dianna (our weekend RN) has been very wonderful and very helpful too, helps us any way she can and answers all questions. Thank you golden rule hospice!

Brando

Vivian our CNA is the best! She always brings supplies and a smile and a sweet caring funny spirit! She always makes sure my nana has what she needs. She is very reliable and knows how to build positive relationships with families. She makes sure nana is cared for. She cleans nana and makes her bed. nana always feels comfortable with her.

Connie F.

My experience with Golden Rule has been outstanding. Every staff member has been professional, knowledgeable, friendly and a joy to work with. The one I value the most is Vivian the CNA. My husband and I love her like family. She takes such good care of him and he always express how much better he feels when she leaves. Take God for her. Also I would like to mention Tyrell the nurse and Elizabeth the social worker. Their work is excellent and very commendable.Your company is one of the best health care companies I have had the pleasure of working with. Thank you so much and may Od Bless you all. Constance Rodgers Faison MSN Nursing Professor

Linda I.

My mom has been under the care of Golden Rule for a year, and she has just thrived! She was somewhat depressed when we first started, but now is really enjoying life again.. my mom will be 100 years old in December. Chris Hill is an outstanding nurse with Golden Rule, I attribute mom’s well being mostly to him. He is genuinely kind and caring! Kathy also does a great job with mom, she won’t let anyone else give her showers .Stanley does an excellent job of spiritual support. Thank you Golfen Rule!

T S.

Golden Rule Hospice has provided excellent care for my loved one for about a month now. We have been assigned a lovely Nurse named Opal who has been so sweet, loving, and attentive. We've also had a few visits from the nurse's lovely aide, Edna for showers for my LO. She has also been so wonderful, loving, and kind. They both really know what they are doing and we appreciate them so much. We briefly met the hospice social worker, Elizabeth, and she seems great too.

Bobbie B.

★★★★★ Exceptional Care and Compassion Golden Rule Hospice provided outstanding care for my Grandmother. The entire team was compassionate, professional, and always available to offer support. I want to give special recognition to Care givers,Reggie, Vivian, and Shamiel—their kindness, dedication, and expertise made a difficult time much easier for our family. They went above and beyond to ensure comfort and dignity, and we are truly grateful for their care. I highly recommend Golden Rule Hospice to anyone in need of quality, compassionate hospice services.