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Hospice Eligibility

Patients are eligible for hospice care when the determination is made that life expectancy is six months or less if the disease follows its usual course. Patients eligible for hospice show decline in status in combination with objective indicators of disease progression. This guide is a reference to factors that indicate life expectancy may be six months or less.

DECLINE IN STATUS

Clinical status examples

  • Increasing hospitalizations, ER or physician visits
  • Recurrent serious infections (i.e. pneumonia or sepsis)
  • Progressive weight loss, malnutrition
  • Dysphagia leading to recurrent aspiration

Poorly controlled symptom examples

  • Dyspnea, increased respiratory rate, cough
  • Nausea, vomiting, and diarrhea
  • Pain requiring increasing doses of analgesics

Signs

  • Systolic BP < 90 or progressive postural hypotension
  • Ascites, edema, or effusions
  • Changed level of consciousness
  • Progressive stage 3-4 pressure ulcers
  • Albumin <2.5 gm/dl

Dependence in two or more ADLs

  • Feeding
  • Ambulation
  • Continence
  • Transfers
  • Dressing
  • Bathing

Also significant in determining eligibility

  • Reduced performance status (as evidenced by reduced PPS/Karnofsky/ECOG)
  • Comorbid conditions yielding a high overall burden of illness

DISEASE SPECIFIC INDICATORS

Dementia

  • Includes: Alzheimer’s, senile dementia, Lewy Body, Parkinson’s, vascular and other dementias
  • Impaired ambulation, speech, continence
  • Aspiration pneumonia, recurrent UTIs
  • Decubitus ulcers, weight loss, frequent falls

Lung disease

  • 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

Neurologic disease

  • Examples Parkinson’s disease, ALS, Multiple sclerosis, Huntington’s chorea, muscular dystrophy, past stroke or chronic ischemic cerbrovascular disease
  • Impaired respiratory function, impaired swallowing
  • Severe nutritional deficiency, Alb <2.5 gm/dl
  • May have symptoms of dementia as above (i.e. weight loss, pressure ulcers)

Heart disease

  • May have history of MI, resuscitation, arrhythmias, embolic infarcts, 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

Liver disease

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

  • Albumin <2.5 gm/dl, INR > 1.5
  • Refractory ascites, peritonitis, hepatorenal syndrome, hepatic encephalopathy, or variceal bleeding

HIV disease

  • CD4+ count < 25 cells/mcL (or)
  • Persistent viral load >100K copies/ml (and)
  • PPS < 50% with AIDS defining infection

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
  • Comborbidities support eligibility

Cancer

  • Stage III b or Stage IV Metastatic disease
  • Treatment refractory myeloproliferative disorders
  • Continued decline despite disease directed treatments, or patient declines treatment

Open access

Palliative procedures and treatment are considered on a case-by-case basis. Examples include the following:

  • Related hospitalizations
  • Paracentesis
  • Blood transfusions
  • Radiation