WHEN IS A PATIENT READY FOR HOSPICE?

"Patients are eligible for hospice care when the physician and hospice medical director make a clinical determination that life expectancy is six months or less, if the disease follows its usual course."

• Chronic Obstructive Pulmonary Disease
• Congestive Heart Failure (CHF)
• Cancer, Dementia
• Diabetes, Renal Failure, Ischemic Cardiomyopathy
• Acquired Immunodeficiency Syndrome (AIDS)

• Metastatic Cancer
• Patient declines further disease directed treatment
• Cancer diagnosis often eligible for hospice without other criteria

• Patient is optimally treated with medical therapy declines/ineligible for further surgical intervention
• NYHA class IV (chest pain, shortness of breath at rest or minimal exertion)
• Ejection fraction of 20% or less (supportive but not required)

• Low CD4+count or elevated, Viral Load
• Persistent wasting, Lymphoma
• Renal failure, Cryptosporidium infection

• Patient is not seeking dialysis, Hepatorenal syndrome
• Advanced lung or cardiac disease
• Uremia, Uremia Pericarditis
• Abnormal Creatinine, Creatinine Clearance

• Dyspnea at rest, bed to chair existence
• Increased ER, physician visits or hospitalization
• Right heart failure, unintentional weight loss
• Resting tachycardia, recurrent pulmonary infections

• Complete dependence for ADLS
• Incontinent bladder & bowel
• Inability to ambulate, dress or bathe without assistance
• Inconsistent meaningful verbal communication; ability to speak is limited to 6 or less words
• Aspiration pneumonia, pressure ulcer, weight loss, UTI's

• Medicare patients awaiting liver transplant may be other criteria certified for hospice care and remain on the transplant list
• INR>1.5 or serum albumin <2.5 gm/dl

• Progressive malnutrition, muscle wasting, continued alcohol abuse, Hepatocellular Carcinoma,
• Hepatitis B or C

• Critically impaired breathing or swallowing
• Rapidly progressive decline
• Pylenonephritis or Sepsis
• Weight loss or dehydration
• Stage 3 pressure ulcers

• Low performance status (bedbound)
• Aspiration, Weight loss
• Assistance with most or all ADLS
• Serum albumin <2.5 mg/ml 7
• Dysphagia that prevents sufficient nutrition
• Pressure ulcer