General Guidelines for Hospice Admission

A lack of symptoms does not automatically disqualify hospice admission. 

  • Increasing ER visits
  • Calling your office more often
  • Slower to bounce back after a set back
  • Family seems more stressed, overwhelmed, unable to handle increasing caregiving duties
  • Patient needing assistance
  • Patient experiencing increased pain, current pain medications seem less effective
  • Patient experiencing issues with breathing distress, nausea or other symptoms
  • Patient’s family expressing that the patient seems emotionally withdrawn, is sleeping more or having difficulty with comprehension
  • The patient or members of their family appear to need emotional support
  • Patient/family choosing to focus on comfort rather than cure of the disease

General Critera

  • Life-limiting condition with prognosis of six months or less if disease progression runs its normal course
  • Patient/family informed that condition is life-limiting and have elected palliative care
  • Frequent hospitalizations
  • Progressive weight loss (taking into consideration edema weight)
  • Increasing weakness, fatigue, somnolence
  • Alteration in cognitive and functional abilities
  • Compromised ADLs
  • Deteriorating mental abilities
  • Recurrent infections
  • Skin breakdown
  • Specific decline in condition

Disease Criteria

Cancer

  • Unintentional progressive weight loss
  • Curative treatment unlikely to improve quality or length of life
  • The burden of treatment on the patient and family outweighs the potential benefits
  • Metastasis to multiple sites
  • Stage III b or Stage IV Metastatic disease
  • Treatment refractory myeloproliferative disorders
  • Continued decline despite disease directed treatments, or patient declines treatment

Chronic Obstructive Pulmonary Disease (COPD)

  • Shortness of breath at rest and with any activity
  • Disabling dyspnea at rest, fatigue and cough from COPD, pulmonary fibrosis, pulmonary HTN
  • Hypoxemia at rest, right heart failure, resting tachycardia
  • Unintentional progressive weight loss
  • Recurring respiratory infections
  • Using multiple inhalers with poor response
  • Increased need for assistance from bed to chair
  • Fatigue and/or increased cough
  • Has made repeated trips every few months to the emergency room for respiratory failure or lung infections
  • Unintentional weight loss

Heart Disease

  • Chest pain and/or shortness of breath with and without activity
  • May have a history of MI, resuscitation, arrhythmias, embolic infractions, syncope, inoperable valvular heart disease, CHF
  • Treatment resistant angina or not a candidate for invasive revascularization procedures
  • NYHA Class III or NYHA Class IV symptoms
  • Fatigue, shortness of breath or functional decline
  • Taking multiple cardiac medications or a poor response to medications
  • Patient and/or physician believe heart surgery is not a preferred option
  • Personal choice not to pursue any further specialized treatment
  • Frequent ED visits or hospitalizations
  • Cardiac arrest or syncope
  • New dysrhythmia

Liver Failure

Patients eligible or awaiting transplant may be considered for hospice care.

  • The patient is a transplant patient whose transplant has failed and the patient is not eligible for, or refuses, another transplant
  • Sudden or progressive loss of functional independence
  • Mainly sit or lie
  • Confusion, cognitive impairment
  • Bowel dysfunction
  • Breathing difficulties
  • Restlessness
  • Albumin <2.5 gm/dl, INR >1.5
  • Refractory ascites. Peritonitis, hepatorenal syndrome, or variceal bleeding

Renal Disease

  • Cr clearance < 15 cc/min
  • Creatinine > 8 mg/dl (or >6 if diabetic)
  • Patient is not seeking dialysis, plans to discontinue dialysis, or can no longer tolerate dialysis
  • Comorbidities support eligibility

Alzheimer’s, Dementia or Parkinson’s

Includes: Alzheimer’s, senile dementia, Lewy Body, vascular and other dementias

  • Continuing weight loss
  • Needs help to sitting up, eating, getting dressed and grooming themselves
  • Unable to walk without assistance, non-purposeful ambulation, or bed-bound
  • Patient shows signs of severe anxiety
  • Impaired speech, bowel and bladder incontinence
  • Aspiration pneumonia, recurrent UTIs
  • Decubitus ulcers, frequent falls

Amyotrophic Lateral Sclerosis (ALS)

  • The patient has become wheelchair or bed-bound
  • Barely intelligible speech
  • Significant shortness of breath/Severely impaired breathing
  • In need of a pureed diet and needs assistance with eating
  • Requires major assistance with dressing and grooming, or is totally dependent on others for these activities
  • The patient does not wish to be dependent on feeding tubes for nutrition and hydration
  • The patient does not want to be placed on a ventilator for breathing, or wishes to discontinue mechanical ventilation

HIV Disease

  • Must have established AIDS diagnosis
  • Decision has been made to forego antiretroviral, antibacterial, antifungal, chemotherapeutic and prophylactic drug therapy related specifically to the AIDS diagnosis
  • Chronic, persistent diarrhea
  • Significant weight loss of 10% or more in past three months
  • Generalized weakness
  • CD4 count < 25 cells/mcL (or)
  • Persistent viral load > 100,000 copies/ml (and)
  • PPS < 50% with AIDS defining infection
  • History of frequent opportunistic infections
  • CHF at rest
  • AIDS dementia complex
  • Toxoplasmosis
  • Generalized wasting

Refer a patient for care

Senior woman hugging and kissing her husband

HOSPICE