Hospice Eligibility Guidelines.

The initial step in determining if a patient is hospice appropriate is the certification that the patient’s prognosis is six months or less if the disease progresses at its normal course (care can be extended beyond six months as long as the patient continues meeting eligibility criteria). This is followed by the confirmation from the patient that he/she prefers hospice and palliative care over that of continued curative treatments.

Additional indicators which support the need for hospice care include:

– A significant increase in the number/frequency of hospitalizations
– A significant number of ER visits
– Multiple co-morbidities
– Loss of function and an apparent physical decline
– The presence of additional indicators such as weight loss, the need for assistance in completing most daily    living activities, and general failing health, etc.

Disease – Specific Indicators

Listed below are disease-specific indicators as outlined by the Medical Guidelines for Determining Prognosis in Selected Non-cancer Diseases 2nd Ed., National Hospice Organization 1996.

Amyotrophic Lateral Sclerosis         

– Unable to walk, needs assistance with ADLs
– Barely intelligible speech
– Difficult swallowing
– Weight loss
– Significant dyspnea
– Co-morbidities pneumonia, URI

Cancer

– Metastasis to multiple sites
– Weight loss
– Patient/family chooses palliative care

CVA and Coma

– Decreased level of consciousness, coma, or
– Persistent vegetative state

Dysphagia

– Paralysis
– Post-stroke dementia
– Decreased nutritional status
– Co-morbidities

Dementia and/or General Decline

– Unable to walk without assistance
– Urinary and fecal incontinence
– Speech limited to a few words
– Unable to dress without assistance
– Unable to sit up or hold head up
– Complications: pneumonia, UTI, sepsis, pressure ulcers
– Difficulty swallowing/eating
– Weight loss

Heart Disease – CHF, NYHA Class III or IV

– Discomfort with physical activity
– Symptomatic despite maximal medical management
– Arrhythmias resistant to treatment
– History of cardiac arrest
– Cardiogenic embolic CVA

HIV/AIDS

– Wasting syndrome
– CNS lymphoma/Kaposi’s sarcoma
– AIDS dementia
– Decision to forego antiretroviral
– Co-morbidities/severe infection

Liver Disease

– Not a transplant candidate
– Ascites despite maximum diuretics
– Peritonitis
– Hepatorenal syndrome
– Encephalopathy with somnolence, coma
– Recurrent variceal bleeding

Pulmonary Disease –COPD

– Dyspnea at rest
– Poor response to bronchodilators
– Recurent pulmonary infections
– Cor pulmonale/right heart failure
– Weight loss
– Resting tachycardia
– Hypercapnia/hypoxemia

Renal Disease

– Plan for discontinuing dialysis
– Displays signs of uremia (confusion, nausea,
– Pruritus, restlessness, pericarditis)
– Intractable fluid overload
– Oliguria
– Hyperkalemia