Hospice Criteria

Your clinical judgment is paramount. To assist in your assessment, if your patient exhibits ONE or MORE of the following CORE and disease-specific indicators, a hospice referral is probably appropriate.

Another key indicator: Would you be surprised if this patient died within the next year? If not, then a referral may be the best course, for the patient and the family.

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CORE Indicators

  • Physical decline
  • Weight loss
  • Serum Albumin <2.5 gm/dl
  • Not responding to nutritional support
  • Frequent ER visits or hospitalizations related to primary dx or multiple co-morbidities
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Amyotrophic Lateral Sclerosis (ALS)

  • Needs assistance with ADL’s
  • Barely intelligible speech
  • Difficulty swallowing
  • Significant dyspnea
  • Declines feeding tube
  • Declines ventilator support
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Cancer

  • Widespread invasion or metastases
  • Progression despite medical intervention
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Congestive Heart Failure

  • Optimally treated with diuretics & vasodilators
  • NYHA Class IV
  • Ejection Fraction =<20%
  • History of cardiac arrest
  • Treatment-resistant arrhythmias
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COPD

  • Dyspnea at rest
  • Recurrent pulmonary infections and/or exacerbations
  • Unintentional weight loss
  • Resting tachycardia >100/min
  • FEV1 <30% predicted
  • O2 sat = or < 88% in room air
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Alzheimer's Disease

FAST Score of 7:

  • Limited ability to speak (1-5 words/day)
  • Non-ambulatory (cannot walk w/o personal assistance)
  • Dysphagia
  • Not responding to nutritional support
  • Weight loss

 

Co-morbidities:

  • Aspiration
  • Pneumonia
  • Urosepsis
  • Decubiti
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HIV/AIDS

  • CD4 level is at or <25 cells/ml
  • Persistent viral load >100,000 copies/ml
  • Not responsive to antiretrovirals
  • Nonadherence to antiretrovirals
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Liver Disease

  • Prothrombin time INR >1.5
  • Serum albumin <2.5gm/dl
  • Ascites despite maximum therapy
  • Peritonitis
  • Hepatorenal syndrome
  • Hepatic encephalopathy refractory to treatment
  • Recurrent variceal bleeding
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Renal Disease

  • Creatinine clearance <10cc/min
  • Serum creatinine >8.0mg/dl
  • Declines dialysis
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Stroke and Coma

  • Poorly responsive or comatose
  • Dysphagia with very limited intake
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