Hospice Eligibility

Sepsis

Hospice-eligible but not previously identified. Prognosis worsens with the following complications:

• Vasopressors
• Mechanical ventilation
• Hyperlactemia
• Acute kidney injury
• Hepatic injury
• Thrombocytopenia

Alzheimer's Disease and other Dementias

Consider hospice if patient meets both:

Fast TC or beyond and recurrent aspiration

One of these complications:

• Pneumonia
• Recurrent UTI
• Sepsis
• Weight loss 10%
• Two stage 3 or 4 pressure ulcers
• Hip fracture
• Swallowing difficult
• Feeding tube decision
• Delirium (frequent episodes)

Lung Disease

Consider hospice if patient meets both:

Dyspnea at rest and/or with minimal exertion while on oxygen therapy with little or no response to bronchodilators

One of these disease progressions:

• Frequent ED visits and/or hospitalizations
• Cor pulmonale/progressive weight loss

Cancer

Consider hospice if patient meets 1,2 and 3:

• Clinical finding of malignancy with widespread or evidence of metastatic disease
• No longer pursuing chemotherapy and/or immunotherapy
• Palliative Performance Scale (PPS) <70

Liver Disease

Consider hospice if patient meets both:

INR > 1.5 and serum albumin :s; 2.5 g/dl One of these complications:

• Recurrent ascites
• Spontaneous Bacterial Peritonitis(SBP)
• Hepatic encephalopathy
• Variceal bleed
• Weight loss 10%
• HRS

Heart Disease/CHF

Consider hospice if patient meets all:

NYHA Class IV (Fatigue, angina, or dyspnea at rest and/ or with minimal exertion)

Multiple ED visits and hospitalizations Not a surgical candidate

Poor response to optimal treatment with diuretics, vasodilators and/or ACE inhibitors

Supporting evidence

• Echo demonstrating an ejection fraction of 20% or less
• Treatment-resistant symptomatic dysrythmias
• History of unexplained or cardiac related syncope
• CVA secondary to cardiac embolism

Stroke or Coma

Consider hospice if patient meets both:

PPS 40%

10% weight loss in 6 months or serum albumin < 2.5 g/dl

Supporting evidence

• Abnormal brain stem response
• Absent verbal response
• Absent withdrawal to pain

Renal Failure

Consider hospice if patient meets all:

Not seeking dialysis or transplant

Creatinine clearance < 10cc

Serum creatinine > 8 (>6 for dialysis)

Renal Failure Supporting evidence

• Uremia, fluid overload
• Encephalopathy, electrolyte imbalances

Huntington's Disease

Consider hospice if patient meets both:

• Stage 7 or beyond according to FAST Scale
• Has had at least one of the following conditions in the past 12 months: Aspiration pneumonia, UTI, Septicemia, multiple stage 3 or 4 pressure ulcers

Amyotrophic Lateral Sclerosis (ALS)

Consider hospice if patient meets 1 or 2:

• Severally impaired breathing with dyspnea at rest, vital capacity less than 30%, requirement of supplemental oxygen at rest
• Rapid disease progression from independent to bed-bound, from normal to puree diet, from AOL's independence to assistance

HIV Disease

Consider hospice if patient meets 1 or 2 and 3

• CD4+count <25 cells/mm3
• Persistence viral load >100,000 copies/ml from two or more assays at least one month apart
• PPS of <50%

Supporting evidence:

• Chronic persistent diarrhea for one year
• Persistent serum albumin <2.5
• Concomitant active substance abuse