Guidelines for Hospice Eligibility

Care & Support Through the Stages of Serious Illness

Guidelines for Hospice Eligibility

It can be challenging to recognize when a patient could benefit from palliative care and hospice

services. This booklet describes clinical guidelines for determining whether and when to refer a patient for palliative or hospice care.

Referrals & Admissions: (800) 930-2770

Table of Contents

Identifying a Primary Hospice Diagnosis.............................. 1 Amyotrophic Lateral Sclerosis (ALS)...................................... 2 Cancer....................................................................................... 3 Cerebral Vascular Accident/Stroke or Coma......................... 4 Dementia/Alzheimer's............................................................. 5 Heart Disease/CHF................................................................... 6 HIV Disease............................................................................... 7 Huntington's Disease.............................................................. 8 Liver Disease............................................................................. 9 Lung Disease/COPD................................................................10 Multiple Sclerosis....................................................................11 Muscular Dystrophy............................................................... 12 Parkinson's Disease................................................................ 13 Renal Failure ? Chronic..........................................................14

APPENDIX 1 ? NYHA Functional Classifications APPENDIX 2 ? Palliative Performance Scale (PPS) APPENDIX 3 ? Functional Assessment Staging (FAST)

TABLE OF CONTENTS

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Identifying a Primary Hospice Diagnosis

Determining a primary hospice diagnosis can be challenging when a patient has some, but not all, of the clinical indicators of a specific disease or condition. The following clinical signs often support hospice eligibility in combination with another primary diagnosis.

1. Rapid decline over the past three to six months, evidenced by:

? Rapid progression of disease ? Progressive decline in Palliative Performance Score (PPS)* ? Weight loss not due to reversible causes and/or declining serum albumin levels ? Dependence on assistance for two or more ADLs: feeding, ambulation, continence, transfer,

bathing or dressing

2. Dysphagia leading to inadequate nutritional intake or recurrent aspiration 3. Decline in systolic blood pressure to below 90 systolic or progressive postural hypotension 4. Increasing ER visits, hospitalizations or physician follow-up 5. Multiple progressive Stage 3 or Stage 4 pressure ulcers in spite of optimal care 6. Frequent falls or increasing problems with balance and weakness 7. Increased lethargy/sleepiness 8. Uncontrolled pain, shortness of breath, nausea/vomiting, anxiety 9. Multiple, recurrent infections 10. Patient appears to be "giving up" physically and emotionally

Agrace is available 24/7 to assist in identifying whether a patient may be eligible for hospice services. *See Appendix 2 for Palliative Performance Scale

1

Amyotrophic Lateral Sclerosis (ALS)

The patient meets at least one of the following (1 or 2):

1. Severely impaired breathing capacity with all of the following findings:

? Dyspnea at rest ? Vital capacity less than 30% ? Requirement for supplemental oxygen at rest ? The patient declines artificial ventilation OR

2. Rapid disease progression with either a or b below: Rapid disease progression as evidenced by

all of the following in the preceding 12 months: ? Progression from independent ambulation to wheelchair or bed-bound status ? Progression from normal to barely intelligible or unintelligible speech ? Progression from normal to pureed diet ? Progression from independence in most or all Activities of Daily Living (ADL) to needing major

assistance by caretaker in all ADL

a. Severe nutritional impairment demonstrated by all of the following in the preceding 12 months:

? Oral intake of nutrients and fluids insufficient to sustain life ? Continuing weight loss ? Dehydration or hypovolemia ? Absence of artificial feeding methods OR

b. Life-threatening complications demonstrated by one or more of the following in the preceding

12 months: ? Recurrent aspiration pneumonia (with or without tube feeding) ? Upper urinary tract infection (Pyelonephritis) ? Sepsis ? Recurrent fever after antibiotic therapy ? Stage 3 or Stage 4 pressure ulcer(s)

In the absence of one or more of the above findings, rapid decline or comorbidities may also support eligibility for hospice care.

2

Cancer

The patient has 1, 2 and 3:

1. Clinical findings of malignancy with widespread, aggressive or progressive disease as evidenced by

increasing symptoms, worsening lab values and/or evidence of metastatic disease

2. Impaired performance status with a Palliative Performance Score (PPS) ................
................

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