Hospice Eligibility

Eligibility

Hospice is available to patients with a terminal diagnosis and life expectancy of six months or less, as determined by the patient's doctor and a hospice medical director. The patient or the family must be aware of the prognosis and decide on comfort care rather than curative treatment for the terminal condition.

The second criteria for hospice eligibility is an assessment by a hospice medical director or a nurse with specialized hospice training.

A patient will be considered to have a life expectancy of six months or less if he/she meets the non-disease specific decline in clinical status guidelines.

Alternatively, the non-disease specific guidelines, plus the applicable disease-specific guidelines listed below can also establish the necessary expectancy.

Guidelines for Non-Cancer Diagnoses

These guidelines are not meant to be inclusive, but are examples of criteria requirements set forth by the National Hospice Organization. A consultation would be necessary to make a definitive determination regarding hospice appropriateness.

Identification of Hospice Appropriate Patients

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 infections in the last 6 months
Patient or family refuses PEG placement
Patient refuses hospitalization or other aggressive treatments
Patient has optimal treatment, but continues to exacerbate
Significant decline in overall health due to multiple medical & function problems End-Stage Cardiovascular Disease
Recurrent, persistent symptoms of CHF despite optimal/maximal treatments, including optimal therapy with diuretics & ACE inhibitors

End-Stage Cardiovascular Disease

Recurrent, persistent symptoms of CHF despite optimal/maximal treatments, including optimal therapy with diuretics & ACE inhibitors
Recent episode of cardiac arrest, syncope, respiratory arrest
May or may not be oxygen dependent
Multiple hospitalizations related to a severe cardiac condition
Inability to perform physical activity of any kind without discomfort, pain or shortness of breath
CVA of cardiac origin, such as embolism
Unstable Weight
Ejection Fraction of <20% • Unstable weight
Uncontrolled edema

End-Stage Pulmonary Disease

Dyspnea at rest
Functional activity is limited so much that patient experiences a “bed-to-chair” existence, disabling dyspnea
Signs of right-sided heart failure
FEV1 <30% of predicted value, post bronchodilator therapy
Multiple ER visits/hospitalizations for pulmonary infections or failure
Weight loss of greater than 10% of body weight in last 3-6 months
Hypoxemia at rest (02 Sat <88% on room air)
Frequent steroid and/or antibiotic use
Resting pulse rate >100 beats/min
Progressive cough & fatigue
Previous requirement of a ventilator secondary to respiratory failure/infection

End-Stage Renal Disease

Candidate for dialysis, but refuses
Stops dialysis to choose palliative care
Creatinine clearance <10ml/min (<15ml/min if diabetic)
Serum creatinine > 8.0mg/dl (>6.0mg/dl if diabetic)
Hepatorenal Syndrome
Uremia
Oliguria (UO 7.0) not responsive to treatment
Intractable hyperkalemia (>7.0) not responsive to treatment

End-Stage Liver Disease

Ascites
Peritonitis
Progressive malnutrition
Muscle atrophy
Recurrent bleeding or esophageal varices
Hepatorenal syndrome (as evidenced by elevated BUN with Creatinine with Oliguria)
Hepatic encephalopathy and/or coma (very late stage)
Prothrombin time >5 seconds over control & Serum Albumin<2.5 mg/dl

End-Stage HIV Disease

Chronic persistent diarrhea for one year, regardless of etiology •
Persistent serum albumin <2.5 g/dl
Concomitant substance abuse
Decisions to forego antiretroviral, chemo therapeutic % prophylactic drug therapy related specifically to HIV disease
Congestive heart failure, symptomatic at rest
CD4+ count below 25 cells/mcl
Persistent serum albumin 100,000 copies/ml
Opportunistic diseases such as CNS lymphoma, progressive multifocal leukoencephalopathy, cryptosporidiosis, wasting, MAC bactermia, visceral Kasposi’s sarcoma, renal failure, AIDS dementia complex or toxoplasmosis

End-Stage ALS (Amyotrophic Lateral Sclerosis)

Rapid progression of in last 6 months, as evidenced by: progression from ambulation or wheelchair to being bed bound; from normal to pureed diet; from independent or partial-assist to total assistance with ADLs; no longer speaks intelligibly
Must exhibit one of the following: impaired breathing ability as evidenced by respiratory infections or failure; nutritional impairment responsible for >10% loss of body weight in <6 months; life-threatening complications like pneumonia, urosepsis, etc.

End-Stage Dementia; Alzheimer’s/Multi-Infarct

Exhibits all of the following: unable to ambulate, dress or bathe without assis- tance; unable to converse meaningfully with others; incontinent of urine & stool
Cannot sit upright in geri-chair or wheelchair without support
Difficulty swallowing food, liquids or medications
No longer smiling or interacting with caregivers
History of frequent UTIs, urosepsis, pneumonia, septicemia • Multiple decubiti
Weight Loss

End-Stage Stroke, CVA

Dysphagia may or may not be a candidate for artificial nutrition/hydration
Age >70 years
Greater than 10% weight loss despite enteral feedings
Co-morbid conditions such as aspiration, pneumonia, multiple decubiti, septice- mia, urosepsis or frequent UTIs
Unable to communicate meaningfully