Referring to VNSNY Hospice and Palliative Care

On this page you’ll find:

• Summary of Programs and Services
• Hospice Referral Form
• Hospice Eligibility Criteria
• GIP Hospice Eligibility Criteria

Summary of Programs and Services

VNSNY Hospice and Palliative Care services include:

• Hospice Care
• VNSNY Cardiac Hospice Care
• VNSNY COPD Hospice Care
• Hospice Care for Veterans
• Family Support Programs

Hospice Referral Form

To refer a patient to VNSNY Hospice and Palliative Care, please use one of the following three options:

1. Submit electronically with the Hospice e-Referral Form.
2. Fax the Hospice Referral Form to 1-212-290-1825.
3. Call our Referral Center at 1-212-609-1900.

Hospice Eligibility Criteria       

If you answer “yes” to any of the following questions, your patient may benefit from VNSNY Hospice and Palliative Care.

• Would you be surprised if this patient lived longer than one year?*
• Is the patient experiencing more frequent hospitalizations or ED visits?
• Would a conversation about goals of care for the time remaining relieve anxiety or improve this patient’s quality of life?

Core indicators for Hospice¹:

• Multiple hospitalizations
• Physical decline
• Weight loss
• Serum albumin < 2.5 gm/dl
• Infections
• Stage 3–4 pressure ulcers
• Multiple comorbidities
• Dependence on assistance for most ADLs
• Signs and symptoms such as increasing pain, dyspnea, nausea/vomiting, edema, pericardial/pleural effusion, ascites
• Karnofsky or Palliative Performance Scale (PPS) score < 70%

For more information and disease-specific indicators, download the VNSNY Hospice Candidate Card.

^{*This is a helpful screening question used nationally. Actual eligibility for hospice care requires the patient’s physician to certify terminal illness (life expectancy of 6 months or less).}

General In-Patient (GIP) Hospice Eligibility Criteria

Hospice patients may be eligible for GIP care when symptoms are such that it is not feasible for care to be safely performed in a home or residential setting. For example:

• Medication issues that require titration
• Unstable condition
• Complicated care—when specialized treatment or care is needed
• Difficult symptoms—when there are ongoing difficult, uncontrolled symptoms

¹ Local Coverage Determination (LCD) for Hospice – Determining Terminal Status (L25678), National Government Services, June 5, 2009.