Admission

Admission Criteria

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
  • 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

(Not specific criteria for hospice admission.)

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
  • 33%, toxoplasmosis, visceral KS, no Rx, MAC bacteremia
  • No Rx
  • Karnofsky ≤ 50; Requires assistance with caring for self

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%
  • Optimally treated, including after load reduction
  • 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

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
  • Comorbid condition (UTIs, pneumonia, septicemia, pressure ulcers)
  • 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

Neurological (Parkinson, ALS, MS)

  • Patient is chair or bedbound
  • Patient has no ventilator support
  • Karnofsky ≤ 50; ADL ≤ 8

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

Renal Disease

  • BUN > 75mg/dl
  • Chronic renal failure with creatinine > 8.0, off dialysis
  • Discontinuing or refusing dialysis
  • Chronic or acute illness than precipitated renal failure
  • Karnofsky ≤ 60; ADL ≤ 20

Stroke/Coma

  • Coma or persistent vegetative state secondary to stroke beyond 3 days duration
  • Any four of the following on day three of coma: abnormal brain stem response, absent verbal response, absent withdrawal response to pain, serum creatinine > 1.5, age > 70
  • Dysphagia severe enough to prevent receiving food and fluids
  • Not a candidate for artificial nutrition and hydration
  • CT or MRI scans indicating poor prognosis
  • Karnofsky ≤ 40; ADL ≤ 8