Admission
Admission Criteria For Hospice
When in doubt, seek a hospice consult. The following items are general prognostic indicators and NOT specific criteria for hospice admission. Find out if you or your loved one is ready for hospice with our Readiness Questionnaire.
General Guidelines
Terminal illness with prognosis of ≤ six months if disease runs its normal course
Patient/representative desire palliative care over curative care
Documented clinical progression of disease
Recurrent infections such as sepsis, pneumonia, upper urinary tract
Frequent hospitalizations or increased visits to physician’s office
Pain requiring increasing doses of major analgesics
Decline in functional status
Karnofsky score ≤ 50
ADL – dependence in 3 of 6 areas
bathing, dressing, toileting, transfer, continence, feeding
Impaired nutritional status
weight loss ≥10% over past 6 months
serum albumin < 2.5 g/L
MISC
Certified by two physicians; typically, referring physician and hospice medical director
Benefit period is 90 days and renewable
Prognostic Indicators by Specific Conditions
(Indicators are not all inclusive and do not guarantee suitability for admission to hospice)
AIDS/HIV
CD4 count < 25 cells/mcl or persistent viral load of > 100,000 copies/ml
Chronic diarrhea for 1 year
Persistent serum albumin < 2.5
Age over 50 years
Continued substance abuse
Toxoplasmosis, CHF, advanced dementia
Forgoing HAART
One of the following: systemic lymphoma, PML, advanced dementia, cryptosporidiosis, wasting
MAC bacteremia, untreated, unresponsive to treatment, or treatment refused
No Rx
Karnofsky ≤ 50; Requires assistance with caring for self
Untreated or persistent wasting (loss of at least 10% lean body mass)
Cancer
Evidence of end-stage disease and/or metastasis confirmed by pathology, radiology or diagnostic tests
Lab/diagnostic studies support disease progression
No longer receiving curative treatment (palliative radiation can be continued)
CHF
Class IV failure
Ejection fraction < 20%
2 to 3 acute care admits for heart failure in the past year
Recurrent heart failure or angina at rest
Discomfort with any activity NYHA Class IV
Karnofsky ≤ 60; ADL ≤ 18
Patient is optimally treated (vasodilators, diuretics, ACE inhibitors, or hydralazine and nitrates)
Dementia
Bed or chairbound with safety precautions, unable to walk, dress, or bathe without assistance
Difficulty swallowing or eating
Unintended weight loss of > 10% over 6 months – progressive weight loss
Largely mute
Urinary and fecal incontinence
Severity of dementia - FAST stage 7 or beyond
Comorbid condition within the past 12 months, aspiration pneumonia, pyelonephritis, septicemia, multiple stage 3-4 decubiti, fever after antibiotics
Karnofsky ≤ 50; ADL ≤ 10
Liver Disease
Documentation of specific liver disease in history & physical
Spends most of time in bed
Albumin < 2.5
INR > 1.5
PT > 5 sec over control
Jaundice
One of the following co morbidities: encephalopathy, history of spontaneous bacterial peritonitis, refractory ascities, recurrent variceal bleeding, hepatorenal syndrome
End-stage cirrhosis
Not a candidate for liver transplant
Karnofsky ≤ 60; ADL ≤ 20
Progressive malnutrition
Neurological (Parkinson, ALS, MS)
Patient is chair or bedbound
Patient needs oxygen at rest
Karnofsky ≤ 50; ADL ≤ 8
Life threatening complications in the last 12 months
Recurrent aspiration pneumonia, pyelonephritis, sepsis, recurrent fever, stage 3 or 4 pressure ulcer
Pulmonary Disease (COPD)
FEV 1 after bronchodilator less than 30% of predicted
Unresponsive to bronchodilators
O2 dependent
Disabling dyspnea at rest
Resting pCO2 > 50, O2 sat off O2< 88, pO2 < 55 on O2
Presence of cor pulmonale
2 to 3 acute care admissions for COPD in past year
Progressive pulmonary disease, e.g., increasing ER visits or hospitalizations for pulmonary infections and/or respiratory failure
Karnofsky ≤ 50; ADL ≤ 18
Resting tachycardia > 100/min
Unable to perform ADLs
Renal Disease
Patient is not seeking dialysis or renal transplant
Creatinine clearance < 10 cc/min (<15 for diabetics)
Serum creatinine >8 mg/di (>6.0 mg/dl for diabetics)
Other conditions such as
Mechanical ventilation
Chronic lung disease
Hepatorenal syndrome
Intractable fluid overload
Advanced cardiac disease
Oliguria (urine output <400 cc in 24 hours)
Stroke/Coma
Stroke
Poor functional status: KPS or PPS of 40% or less
Inability to maintain hydration and caloric intake with one of the following:
Weight loss
Serum albumin <2.5 gm/dl
Current history of pulmonary aspiration
Sequential calorie counts documenting inadequate intake
Dysphagia severe enough to prevent the patient from receiving foods/fluids necessary to sustain life
Coma
Any etiology with 3 of the following on the third day of coma:
Abnormal brain stem response
Absent verbal response
Absent withdrawal response to pain
Serum creatinine > 1.5 gm/dl
Parkinson’s Disease
Classified as Stage V Parkinson’s Disease
Unable to perform ADLs
Non-ambulatory with no further rehabilitation potential
Increase in dementia
Deteriorating nutritional status
Severe dysphagia resulting in frequent choking episodes
Bowel/Bladder dysfuntion