Admission

Admission Criteria or 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/di 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 dimentia

  • Deteriorating nutritional status

  • Severe dysphagia resulting in frequent choking episodes

  • Bowel/Bladder dysfuntion