VNS Health provides comprehensive hospice care to New Yorkers. We believe that end-of-life services should be built on a foundation of compassion along with expert, high-quality care.
By referring your patient to VNS Health, you can know that they will be treated with dignity and compassion — every single day.
Refer a Patient to Hospice Care
VNS Health accepts hospice referrals from physicians, nurse practitioners, and physician assistants. Physicians must certify terminal illness.
Refer a Patient Online
Submit a referral online with our hospice e-referral form.
Refer a Patient by Phone
To refer a patient for hospice care by phone, call VNS Health Hospice Care at 1-212-609-1900.
Refer a Patient by Fax
Download our hospice referral form and fax to 1-212-290-1825.
Hospice Eligibility Criteria
It can be difficult to know when a person’s illness has advanced to the point when hospice care is appropriate. As you get started, consider these three questions:
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Would you be surprised if this patient lived longer than a year?*
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Is the patient experiencing more frequent hospitalizations or ED visits?
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Would a conversation about goals of care for the time remaining relieve anxiety or improve this patient’s quality of life?
You can always contact VNS Health for guidance in determining eligibility and learning about hospice referral requirements. We can also assist with difficult conversations and in talking to patients and their families about goals of care.
*This is a helpful screening question used nationally. Actual eligibility for hospice requires a patient’s physician to certify terminal illness (life expectancy of 6 months or less).
Core Indicators for Hospice
- Karnofsky or Palliative Performance Scale (PPS) score <70%
- Stage 3–4 pressure ulcers
- Serum albumin < 2.5 gm/dl
- Multiple hospitalizations
- Multiple comorbidities
- Physical decline
- Weight loss
- Infections
- Dependence on assistance for most ADLs
- Signs and symptoms such as increasing pain, dyspnea, nausea or vomiting, edema, pericardial/pleural effusion, ascites
Indicators for Dementia Hospice Care
Patients with Alzheimer’s disease or other end-stage dementias may be eligible for hospice if they meet the following criteria:
- Stage 7 according to the Functional Assessment Staging (FAST) scale, including:
- Unable to walk/dress/bathe without assistance
- Urinary and fecal incontinence
- No consistently meaningful verbal communication
- One of the following within the past 12 months
- Aspiration pneumonia, pyelonephritis, or septicemia
- Multiple pressure ulcers, or Stage 3-4
- Fever, recurrent after antibiotics
- Insufficient fluid and calorie intake
Disease-Specific Indicators for Hospice
Several diseases, heart disease, COPD, cancer, renal disease, and liver disease, have additional indicators for hospice.
No hemodialysis, no renal transplant
In combination with at least one of the following:
- Creatinine clearance < 10 cc/min (<15 cc/min with diabetes or CHF; <20 cc/min with diabetes and CHF)
- Serum creatinine > 8.0 mg/dl (>6.0 mg/dl in diabetics)
- Signs and symptoms of uremia
- Intractable fluid overload
- Oliguria
• PPS <_ 60% ; Not a candidate for curative treatment;
Metastatic Disease
• High symptom burden
• High risk for hospitalization
• Extreme fatigue
• Caregivers unable to manage the plan of care at home
• High degree of psycho-social distress
• NYHA Class IV Heart Failure; angina
• Discomfort with physical activity
• Ejection fraction <=20%
• Arrhythmias resistant to treatment
• History of cardiac arrest or resuscitation
• Brain embolism of cardiac origin
• Medically optimized with cardiac meds or unable to
tolerate
• Not a candidate for or declined surgical intervention
• PT > 5 sec, or INR > 1.5
• Serum albumin < 2.5 gm/dl
In combination with at least one of the following complications:
• Ascites despite maximum diuretics
• Spontaneous bacterial peritonitis
• Glomerular filtration rate (GFR) < 10 ml/min
• Hepatorenal syndrome
• Hepatic encephalopathy
• Recurrent variceal bleeding
• Progression of end-stage pulmonary disease
• Dyspnea at rest or with minimal exertion
• Recurrent pulmonary infections
• Hypoxemia at rest on room air, oxygen saturation
≤ 88%, or Hypercapnia
• Right heart failure secondary to pulmonary disease
and/or resting tachycardia >100/min
Hospice Insurance Requirements
Medicare, Medicaid, the Department of Veterans Affairs, and most private insurance companies cover hospice care. Medicare Part A has specific requirements that patients must meet; call us if you have questions.
In New York State, insurers are required by law to cover hospice care. But private insurance companies may limit benefits and coverage. If your patient has private insurance, they should check with their plan.
Hospice Services Areas
We provide hospice care in NYC. Our service areas include:
- The Bronx
- Brooklyn
- Manhattan
- Queens
- Staten Island
