What does hospice require from me if I make a referral?

  • Physician order to admit to hospice
  • History and physical
  • Signed certification of terminal illness which states a probable prognosis of 6 months or less if disease follows its natural course (may remain in hospice more than 6 months if the patient continues to decline)

Follow these links to find out more about the Referral Process and find our online Referral Form.


How do I identify a potential hospice patient?

  • Terminal diagnosis with probable prognosis of 6 months or less
  • Frequent hospitalizations or emergency room visits
  • Recurrent infections in last 6 months
  • Weight loss of 10% or more in last 6 months
  • Patient refuses hospitalization, aggressive treatment, or PEG tube placement
  • Home health patient in declining status

View Father Lavastida Video


What criterion is necessary to be admitted to hospice service?

  • To qualify for hospice care, two physicians must agree that the patient has an estimated life expectancy of six (6) months or less, if the illness runs its normal course; the patient and family desire palliative care; a physician has been identified to coordinate care of the patient and the patient must reside in agency’s service area.
  • What are some of the diagnoses of patients who receive hospice care?
  • Diagnoses may include: Cancer; Chronic Obstructive Pulmonary Disease; Heart Disease; Dementia (Alzheimer’s); End Stage Renal disease; Stroke; End Stage Liver disease; Failure to Thrive; Unspecified Debility; Lou Gehrig’s disease; Parkinson’s disease; and AIDS.


What are some of the signs and symptoms of a terminal patient that would be appropriate for hospice care?
Signs and symptoms may include:

  • patient not eating or drinking well enough to sustain weight
  • weight loss of 10% or more in 6 months or less
  • recurrent infections in last 6 months
  • frequent hospitalizations in last 6 months
  • patient or family refuses artificial nutrition and hydration methods
  • patient refuses hospitalization or other aggressive treatments
  • patient has optimal treatment, but continues to exacerbate
  • a significant decline in overall health due to multiple medical and function problems


What are advance directives?
They are documents that allow the patient to state what kind of medical treatment they want or don’t want in the event that they become unable to communicate their wishes.
Louisiana Advance Directives Information
Louisiana Advance Directives Form


Are hospice services for the patient only?
Hospice provides support to the patient, family members and caregivers. Up to 13 months of bereavement services such as telephone calls, cards, and memorial services are available to loved ones.


Additional Resources:

Louisiana-Mississippi Hospice and Palliative Care Organization
National Hospice and Pallative Care Organization
The American Hospice Foundation
National Association for Homecare & Hospice
Hospice Foundation of America
National Family Caregivers Association
American Cancer Society
National Cancer Alliance
American Association of Cancer Research
Alzheimer’s Association
Amyotrophic Lateral Sclerosis/Lou Gehrig’s Disease
American Heart Association
American Lung Association
Heart Failure Society of America
The Leukemia & Lymphoma Society
Advance Directives
State-specific Advance Directives
Louisiana Physician Order for Scope of Treatment (LaPOST)
Medicare Hospice Benefits
Dementia Resources