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Referring to VNSNY Hospice and Palliative Care

vnsny_sandy-seagate-cc_2013_289_013-copyOn this page you’ll find:

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.

Submit hospice referrals electronically

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.

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