You judge hospice eligibility by Medicare rules. You judge readiness by what patients and families can accept now. When you align both, you prevent avoidable hospitalizations, reduce symptom burden, and support goals that matter.

This guide gives you quick eligibility checkpoints, practical “readiness” signals, and a 10-minute workflow you can use in busy primary care and hospital settings across Dallas-Fort Worth.

Quick Takeaways for Busy Clinicians

Eligibility requires a terminal illness with an expected prognosis of 6 months or less if the disease runs its normal course and physician certification.
Readiness reflects willingness, understanding, caregiver capacity, and goals that fit a comfort-focused plan.
Functional status tools help: PPS less than 70 percent suggests survival beyond 6 months is unlikely; FAST stage 7C or worse in dementia commonly aligns with hospice eligibility. Use these to guide timing and documentation.
Hospice has four levels of care: routine home care, continuous home care, inpatient respite, and general inpatient. Match level to need during crises or symptom escalation.
Hospice is flexible. Patients may revoke, transfer, or re-elect hospice. Choosing hospice is not a one-way door.

Eligibility vs. Readiness: What You Must Distinguish

Eligibility is regulatory. Medicare requires that you, as the attending or hospice physician, certify a terminal prognosis of 6 months or less if the illness runs its normal course. Recertification at defined intervals is required to continue services.

Readiness is clinical and relational. It means the patient and family understand options, feel the burden of treatment exceeds benefit, and can accept a comfort-oriented plan. Readiness is often the bottleneck even when eligibility is met.

How to Recognize Patient Readiness in Real Clinics

Use these cues to decide when to lean into a hospice conversation:

Functional decline
- PPS trending below 70 percent, with weight loss, reduced intake, rising dependence in ADLs.
Disease-specific milestones
- Dementia: FAST stage 7C or worse, plus comorbidities or dementia-related complications like aspiration or recurrent infections.
- Advanced heart or lung disease: Refractory symptoms at rest, frequent exacerbations, and intolerance of guideline-directed therapy.
Utilization signals
- Two or more ED visits or hospitalizations in the last 90 days for the same progressive condition despite optimized therapy.
Patient-reported outcomes
- Signal sentences: “I am tired of the hospital,” “I want to be at home,” “I do not want more invasive treatments.”
Caregiver capacity and safety
- Nighttime distress, burnout, or unsafe transfers that point to a need for continuous home care or inpatient respite when crises arise.

Condition-Specific Signals You Can Document

Advanced Dementia: Eligibility and Readiness

Eligibility often aligns with FAST 7C or worse with complications such as aspiration pneumonia, sepsis, or significant weight loss.
Readiness shows as caregiver exhaustion, feeding intolerance, distress with transfers, and family goals that prioritize comfort at home.

Write, “FAST 7D with recurrent aspiration and PPS 40 percent. Family goal is comfort at home.” That sentence connects eligibility and readiness in one line.

Heart Failure and COPD: Frequent Crises, Rising Burden

Refractory dyspnea at rest, hypotension or renal dysfunction that limits disease-modifying therapy, and two or more hospitalizations in 90 days.
PPS at or below 60-70 percent correlates with higher near-term mortality and can cue earlier hospice discussions. Discover why early hospice referral matters, read our guide: Why Earlier Hospice Support Brings More Comfort

Note objective markers like BNP trend, home oxygen needs, six-minute walk intolerance, and repeated steroid bursts for COPD.

Advanced Cancer: Declining Performance and Treatment Futility

ECOG 3-4 or PPS 50 percent and falling, no further effective systemic options, or unacceptable toxicity.
Readiness often appears when patients prefer to spend time at home, avoid the infusion center, and focus on symptom relief.

What to Say When the Patient is Eligible but “Not Ready”

Offer a bridge:

Schedule palliative care follow-up and a hospice information visit.
Focus on symptom control now with trials of PRN opioids for dyspnea, bowel regimen, and anti-emetics as indicated.
Revisit goals after the next crisis is averted. Many patients become ready after a clear, compassionate explanation and one more exacerbation that shows the limits of hospital-based care.

Understanding Hospice Levels of Care, So You Can Set Expectations

Patients and families worry about what happens during a crisis. Medicare covers 4 levels of care whichever matches the patient. A clear explanation builds trust:

Routine home care: Baseline support at home or in a facility.
Continuous home care: Short-term, high-intensity nursing in the home during a symptom crisis.
Inpatient respite care: Short stay to relieve caregivers.
General inpatient care: Short-term hospital or hospice unit stay for uncontrolled symptoms.

Tie levels of care to readiness: “We can start at home. If symptoms flare, we can increase support or move to inpatient care briefly, then come back home.” This framing helps families feel safe choosing hospice earlier.

Flexibility Matters: Election, Revocation, and Transfers

Reassure patients that hospice is patient-controlled:

A patient may elect hospice when eligible.
A patient may revoke hospice at any time in writing to pursue disease-directed care, then re-elect later if eligible.
A patient may transfer between hospice providers within a benefit period. These rights are part of the Medicare hospice benefit.

This flexibility lowers the barrier to starting hospice. Say, “You can try hospice. If goals change, you can pause and return to it later.”

Documentation Essentials that Speed Approvals

Diagnosis and trajectory: “Progressive systolic heart failure with refractory dyspnea.”
Functional status: PPS percentage and trend.
Disease milestones: FAST stage in dementia, objective markers in CHF/COPD or cancer.
Utilization: ED visits or admissions with dates.
Goals and readiness: “Patient prioritizes comfort at home, wants to avoid ICU.”
Plan: Hospice info visit ordered, DME and comfort meds arranged.

These elements support eligibility and show readiness, which reduces delays at admission and during recertification.

Local Referral Pathway in Dallas-Fort Worth

When you see the signals above, contact our team for a same-day discussion. We admit across Dallas, Collin, Denton, Tarrant, Ellis, Kaufman, and Rockwall Counties. We coordinate with your office or hospitalist group, deliver DME, arrange on-call visits, and provide music therapy, chaplaincy, social work, veterans services, and volunteers to support families at home.

Start with a no-obligation information visit.
We confirm eligibility, assess readiness, and build a plan that honors goals and culture.
We communicate back to you with PPS, levels-of-care use, and outcomes.

Ask Referral Questions in North Texas Today

If you are ready to discuss a patient now, call (469) 480-1130 . You can also share brief clinical details through our contact page, and we will coordinate an information visit the same day whenever possible.

If you need hospice care in Dallas County, Collin County, Denton County, Ellis County, Kaufman County, Rockwall County, or Tarrant County, call our team to arrange a same-day hospice information visit.