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Is Hospice the answer?

Hospice care can provide quality of life and dignity at home when there is a life-limiting illness. Complete the brief questionnaire to see if hospice might be right for your family.
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Angels Care Hospice, part of the AngMar Medical Holdings, Inc. network, is a premier provider of hospice services in the communities we serve. Our comprehensive, holistic approach to hospice care centers around reducing the fear and burden associated with the end of life journey. This approach allows our patients and their families to live the fullest and most meaningful life possible wherever the patient calls home, including assisted living facilities, hospitals or long-term care facilities.

Our Interdisciplinary TeaM

Hospice & Palliative

Care Basics

Considering the end of life is not easy, whether you are planning for the future or coping with serious illness right now. Angels Care Hospice provides compassionate hospice care to patients with a life-limiting illness. Our interdisciplinary care team focuses on symptom management, pain relief and quality of life for patients facing life-limiting illnesses. Explore a range of supportive, Angels Care Hospice-provided resources in more detail.

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Search Angels Care Hospice’s network of multiple agencies with locations in seven states, including Arizona, Kansas, Iowa, Nebraska, Oklahoma, Texas, and Virginia.

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Contact us

  • 2301 FM 1187, Suite 203 Mansfield, TX 76063-6139
  • Toll Free: 877-469-6739
  • Local: (817) 469-6739
  • Fax: 817-801-3486
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Volunteers

  • Volunteers can provide direct patient care services or administrative services.


  • Direct care volunteers can provide support to patients and caregivers by visiting with the patient, sitting with the patient to allow for caregiver respite, or reading to the patient.


  • Administrative volunteers serve in the office helping make admission packets, answering the phones, and making “tuck in” calls to ensure patients have all items needed for the weekend.


  • Volunteers may assist in special projects like sewing items for patients, making memory bears or creating other items.


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General Eligibility

Early identification of hospice eligible patients increases the likelihood that they and their families will benefit from hospice care. Physicians must certify that patients meet guidelines determined by CMS to be eligible for admission to a hospice provider.

General Eligibility Guidelines

For a patient to be eligible for hospice, the physician should consider the following guidelines:

  • The illness is terminal (a prognosis of ≤ 6 months) and the patient and/or family has elected palliative care.
  • The patient has a declining functional status as determined by either:
    • Palliative Performance Scale (PPS) rating of ≤ 50% for non-cancer diagnoses or ≤for cancer diagnoses
    • Dependence in 3 of 6 Activities of Daily Living (ADLs)
  • The patient has alteration in nutritional status, e.g., > 10% loss of body weight over last 4-6 months
  • The patient has a documented deterioration in overall clinical condition in the past 3-6 months, as manifested by at least one of the following:
    • ≥ 3 hospitalizations or ED visits
    • Decrease in tolerance to physical activity
    • Decrease in cognition
  • Other comorbid conditions are likely to contribute to the life expectancy of 6 months or less
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The 4 levels of Hospice Care

Every Medicare certified hospice provider must provide the four levels of hospice care as defined by The Centers for Medicare and Medicaid Services. The four levels of hospice care are routine hospice care, continuous home care, general inpatient care and respite care. A patient may experience all four levels of care or just one level of care throughout the duration of their hospice care. As every hospice patient is unique, their level of hospice care will be specific to their individual need. A patient may only receive one level of care type per day.

Routine hospice care is the most common level of hospice care and is provided wherever the patient calls home (private residence, assisted living facility, nursing facility, etc.).

Continuous home care is provided during brief periods of patient crisis as necessary to keep the patient at home. Predominately nursing care is provided for at least 8 hours of a 24-hour period.

General Inpatient (GIP) care may only be provided in a Medicare participating hospital, skilled nursing facility or hospice inpatient facility on a short-term basis for pain control or acute/chronic symptom management that cannot be provided in other settings.

Respite care is provided to allow short term temporary relief to the patient’s primary caregiver, limited of 5 consecutive days. Respite care must be provided in a Medicare certified inpatient hospice facility, Medicare-certified hospital or a skilled nursing facility. The patient is admitted to a certified facility and returns home after the 5 days.

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Can I choose to stop hospice care once I start?

Yes. Once a patient elects hospice, they may choose to revoke their hospice care services at any point. Some patients decide they would like to give curative treatments another try and must revoke hospice services. When the patient revokes hospice services, they are revoking the Medicare hospice benefit including the medical equipment, visits by hospice staff and medication coverage

There are situations where a patient’s health improves, and they no longer have a 6 month or less prognosis. Once the hospice medical director determines the patient will live beyond 6 months, hospice services will be discontinued once the patient and hospice staff review the discharge plan. If the patient’s health declines in the future, the hospice staff and physician can reassess the patient to determine if the patient is hospice eligible again.

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Is hospice the same as home health?

While there are similarities between hospice and home health, there are also differences. Both provide care in the patient’s home and while home health is more curative, hospice is more palliative in nature. The goal of both is to avoid and reduce hospitalizations. If unsure of which type of care needed, our staff can help assist with determining the appropriate level. To help learn more about the differences between home health and hospice, please refer to the information below.

Q. Does a patient have to be homebound to receive hospice care?
A. Hospice patients do not have to be homebound and are able to leave their home, including taking a trip if they feel well enough. Home Health patients must be certified by a physician as having a homebound status. They must be homebound except for short durations of time.

Q. If my loved one is in a long-term care facility can they receive home health and hospice services?
A. If a patient is in a long-term care facility, they may receive hospice services as hospice is provided wherever the patient calls home. Home Health is provided in the patient’s private residence and cannot be provided to patients in a long-term care facility.

Q. Who provides hospice and home health care services?
A. The team who provides home health and hospice is suited to meet the needs and goals of each individual patient.

  • The hospice interdisciplinary team consists of the hospice physician, nurses, hospice aides, social workers, chaplains, volunteer coordinator and a bereavement coordinator.
  • The home health team is specific to the skilled care relating to the patient’s diagnosis including, but not limited to, registered nurses, occupational therapists, speech/language pathologists, physical therapists and certified nursing assistants.

Alzheimer's Dementia Eligibility

Alzheimer’s disease and other progressive dementias are life limiting conditions for which curative therapy is not available. Patients with dementia or Alzheimer’s are eligible for hospice care when they show the following characteristics: Patient should be at least stage 7 on the FAST scale as evidenced by:

  • Unable to ambulate without assistance
  • Unable to dress without assistance
  • Unable to bathe properly
  • Incontinence of bowel and bladder
  • Unable to speak or communicate meaningfully (ability to speak is limited to approximately a half dozen or fewer intelligible and different words)


Secondary diagnoses associated with advanced dementia include:

  • Aspiration pneumonia
  • Pyelonephritis or upper urinary tract infection
  • Septicemia
  • Decubitus ulcers, multiple, stage 3-4
  • Fever recurrent after antibiotics
  • Impaired Nutritional Status as evidenced by one or more of the following:
    • Difficulty swallowing or refusal to eat
    • If receiving artificial nutritional support (NG or G-tube, TPN), patient must be exhibiting continued weight loss despite the feedings
    • Protein calorie malnutrition as evidenced by:
    • Weight loss over 11% or
    • BMI<18 or
    • Albumin <3.1

Co-morbid conditions that might significantly impair the dementia patient’s health and functionality:

 

  • Congestive heart disease or cardiovascular disease
  • COPD or restrictive lung disease
  • Cerebrovascular disease, including stroke
  • Diabetes mellitus
  • Renal insufficiency
  • Malignancy
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Hospice Eligibility for Heart Disease

Patients are eligible for hospice care when a physician makes a clinical determination that life expectancy is six months or less if the disease runs its expected course. 

Characteristics of end-stage congestive heart disease:

  • New York Heart Association (NYHA) Class III if any of the following symptoms are present during any activity:
    • Fatigue
    • Palpitations
    • Angina or dyspnea with activity
  • NYHA Class IV as manifested by any of the following symptoms:
    • Dyspnea and/or other symptoms at rest or with minimal exertion
    • Inability to carry out physical activity without dyspnea and/or other symptoms
    • Dyspnea and/or other symptoms worsen with physical activity
  • The patient is being optimally treated for congestive heart failure with diuretics and vasodilators, such as ACE inhibitors, or they are maximally medically managed and have no available surgical options.

Characteristics of end-stage coronary artery disease:

  • Patient has frequent or recurrent bouts of angina pectoris at rest or with minimal activity.
  • Patient is symptomatic despite standard nitrate therapy.
  • Patient is not a candidate for (or declines) invasive procedures, such as percutaneous angioplasty or coronary artery bypass surgery.

Comorbid factors:

  • Symptomatic supraventricular arrythmias despite antiarrhythmic therapy
  • History of cardiac arrest
  • History of syncope from any cause
  • Cardiogenic brain embolism
  • Concomitant HIV disease
  • Renal failure
  • COPD
  • Cardiovascular accident (CVA, or stroke)
  • Liver failure
  • Cancer
  • Dementia
  • Smoking
  • Diabetes
  • Hypertension
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Hospice Eligibility Guidelines for COPD and Lung Disease

Major factors
  • Disabling dyspnea at rest or with minimal exertion
  • Dyspnea unresponsive or poorly responsive to bronchodilator therapy
  • Progression of chronic pulmonary disease as evidenced by one or more of the following:
    • Frequent hospitalizations, ED visits and/or physician outpatient visits for infections or respiratory failure
    • Frequent episodes of bronchitis or pneumonia
    • Unintentional weight loss of ≥ 10 percent body weight over the preceding six months
    • Progressive inability to independently perform various activities of daily living (ADLs) or increasing dependency with ADLs, resulting in a progressively lower performance status.

Other contributing factors

  • Cor pulmonale
  • Continuous chronic oxygen therapy
  • Resting tachycardia > 100/minute
  • Steroid dependent
  • Cyanosis

Abnormal laboratory findings

While these laboratory studies may be helpful to the clinician when considering patient eligibility for hospice services, they are not required for patient admission.
  • FEV1 ≤ 30 percent predicted post-bronchodilator
  • Serial decreases in FEV1 of at least 40 ml/year over several years
  • PO2 ≤ 55 on room air
  • O2 saturations ≤ 88 percent on room air
  • Persistent hypercarbia (PCO2) ≥ 50 mm HG
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Hospice Eligibility Guidelines for Cancer

To be eligible for hospice a patient should meet the following guidelines:

1. Disease with metastases at presentation OR;
2. Progression of disease to metastatic disease with either:

  • Continued decline in spite of therapy such as chemo or radiation and patient is discontinuing therapy OR;
  • Patient refuses aggressive therapies

OR

3. Patient is diagnosed with a cancer that is known to have a poor prognosis such as small cell lung cancer, brain cancer, or pancreatic cancer.

Palliative Performance Scale for Functional Status

In general, a cancer patient who scores 70% or lower on the Palliative Performance Scale may be eligible for hospice. These patients typically:

  • Are unable to carry on normal activity or do normal work
  • Spend more than 50% of their time in a bed, chair or a single room
  • Exhibit evidence of significant disease
  • Can provide only limited self-care
  • Have reduced nutritional intake


ECOG Score for Functional Status

The biggest predictor of hospice eligibility in oncology, is the patient’s functional status using the Eastern Cooperative Oncology Group (ECOG) scale. If your patients have decreased functional status and are spending an increasing amount of time sitting or lying down, a rough estimate of the prognosis is three months or less.

Using the ECOG scale, a median survival of three months roughly correlates with a score of >3. An ECOG score of 2 is generally supportive of being eligible for hospice services.

  • 0: Asymptomatic
  • 1: Symptomatic but completely ambulatory
  • 2: Symptomatic, <50% in bed during the day
  • 3: Symptomatic, >50% in bed but not bedbound
  • 4: Bedbound
  • 5: Death
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ALS Eligibility

Patients are considered to be hospice eligible for amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) when a physician makes a clinical determination that life expectancy is six months or less if the disease runs its normal course and they meet the following guidelines:

  • Both rapid progression of ALS and critically impaired ventilatory capacity or
  • Both rapid progression of ALS and critical nutritional impairment with a decision not to receive artificial feeding or
  • Both rapid progression of ALS and life-threatening complications such as:
    • Recurrent aspiration pneumonia
    • Decubitus ulcers, multiple, stage 3-4, particularly if infected
    • Upper urinary tract infection, e.g., pyelonephritis
    • Sepsis
    • Fever recurrent after antibiotics


In end-stage ALS, two factors are critical in determining prognosis: ability to breathe and ability to swallow. ALS may be complicated by secondary and co-morbid conditions. Secondary conditions, such as dysphagia, pneumonia and pressure ulcers, are a direct result of the impairment of respiratory functions, swallowing, muscle power and muscle tone that are common in ALS. Co-morbid conditions, which often accompany the rapid progression of ALS, include chronic obstructive pulmonary disease (COPD), pyelonephritis or upper urinary tract infection, septicemia and fever after recurrent antibiotics. While feeding tubes may be a normal part of treatment in ALS, G-tubes and ventilator support prolonged life expectancy. Hospice eligible patients are those who have chosen to forego supportive ventilation, artificial hydration and nutrition.

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Bereavement Counselor

  • Provides bereavement support to families/caregivers up to one year following the death of the patient. Angels Care follows the family for 13 months to provide support through the anniversary of the patient’s death.

  • Supports includes sympathy cards from the team, monthly/quarterly mailings, phone calls and counseling visits as needed.

  • Makes referrals to professionals for those at risk.

  • Provides support for hospice staff, as well as facility staff when appropriate.

  • Hosts community bereavement support groups.

  • Hosts a yearly memorial service for all of the bereaved.

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Alzheimer's Dementia Eligibility

Alzheimer’s disease and other progressive dementias are life limiting conditions for which curative therapy is not available. Patients with dementia or Alzheimer’s are eligible for hospice care when they show the following characteristics:

  • Unable to ambulate without assistance
  • Unable to dress without assistance
  • Unable to bathe properly
  • Incontinence of bowel and bladder
  • Unable to speak or communicate meaningfully (ability to speak is limited to approximately a half dozen or fewer intelligible and different words)
 

Patient should be at least stage 7 on the FAST scale 


Secondary diagnoses associated with advanced dementia include:

  • Aspiration pneumonia
  • Pyelonephritis or upper urinary tract infection
  • Septicemia
  • Decubitus ulcers, multiple, stage 3-4
  • Fever recurrent after antibiotics
  • Impaired Nutritional Status as evidenced by one or more of the following:
    • Difficulty swallowing or refusal to eat
    • If receiving artificial nutritional support (NG or G-tube, TPN), patient must be exhibiting continued weight loss despite the feedings
    • Protein calorie malnutrition as evidenced by:
    • Weight loss over 11% or
    • BMI<18 or
    • Albumin <3.1
 

Co-morbid conditions that might significantly impair the dementia patient’s health and functionality:

  • Congestive heart disease or cardiovascular disease
  • COPD or restrictive lung disease
  • Cerebrovascular disease, including stroke
  • Diabetes mellitus
  • Renal insufficiency
  • Malignancy
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Doctors

  • The Hospice Medical Director reviews the clinical information for each hospice patient and provides written certification that the patient’s life expectancy is 6 months or less.

  • The patient’s Attending Physician (MD, DO, NP or PA) may also remain involved in the patients care if they choose. The attending physician has the most significant role in the determination and delivery of the patient’s medical care.

  • The patient may choose the Hospice Medical Director to be their attending physician.

  • The physicians provide medication and treatment orders for each patient under hospice care.
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Social Workers

  • Social workers assess the psychosocial status of patients and their families/caregivers related to the patient’s terminal illness.

  • If a patient desires social services, the social worker can assist with planning funeral arrangements and helping coordinate financial and healthcare decision responsibilities.

  • Educate and assist the patient/family with preparing advanced directives.
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Nurses

    • All hospice patients must be seen by a Registered Nurse (RN) a minimum of every 15 days or as frequently as the condition of the patient requires.

 

    • Hospice must designate a RN Case Manager to coordinate the patient’s care and assess the patient’s and family’s needs.

 

    • Licensed Practical Nurses/Licensed Vocational Nurses are also used to see patients for routine nursing needs.

 

    • RN must make an on-site visit no less frequently than every 14 days to assess the quality of care provided by the hospice aide for those patients receiving aide services.

 

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Hospice Aide​s

  • Assigned to a specific patient by the RN.

  • Assists with activities of daily living such as bathing and toileting.

  • Often the team member who sees the patient the most and reports changes to the RN.

  • The eyes and ears of the hospice nurse.

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Chaplain

  • Provide intradenominational support to the patient and family.

  • Address spiritual and religious issues and coordinate appropriate interventions.

  • Conducts funeral or memorial services for patients as requested.

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Patients and Families are at the Center of Hospice Care​

Our hospice care is centered around the patient and their family allowing them to make the decisions regarding their care. Our interdisciplinary team provides the care specific to the needs and goals of each patient and family. The nurse will provide hands on care, the social worker will help with advanced directives, the chaplain will offer spiritual support, the hospice aide will help with personal care such as bathing, the bereavement counselor will provide grief and loss counseling, volunteers may read to the patient and the physician will coordinate with the patient’s attending physician, if applicable, consult on pain and symptom management and oversee the hospice plan of care.