Who Is Eligible for Hospice Care?
- The illness is terminal (a prognosis of ≤ 6 months) and the patient and/or family has elected palliative care.
- The patient has a declining functional status as determined by either:
- Palliative Performance Scale (PPS) rating of ≤ 50%-60%
- Dependence in 3 of 6 Activities of Daily Living (ADLs)
- The patient has alteration in nutritional status, e.g., > 10% loss of body weight over last 4-6 months
- The patient has an observable and documented deterioration in overall clinical condition in the past 4-6 months, as manifested by at least one of the following:
- ≥ 3 hospitalizations or ED visits
- Decrease in tolerance to physical activity
- Decrease in cognitive ability
- Other comorbidities
Disease-Specific Guidelines for Hospice Eligibility
ALS
In end-stage ALS, the ability to breathe and swallow are two determining factors.
Alzheimer’s and Dementia
Patients with dementia or Alzheimer’s who can no longer move around, perform personal care tasks, or speak properly.
COPD and Lung Disease
Patients with COPD and lung disease experience dyspnea at rest or with minimal exertion.
Heart Disease
Patients with heart disease that often experience shortness of breath, chest pain, weakness, functional decline, and the management of fluid status.
HIV and AIDS
HIV/AIDS patients with low CD4 counts, decreased performance on the KPS scale, and documentation of certain factors.
Liver Disease
Liver disease patients with persistent symptoms of hepatic failure, such as ascites, hepatic encephalopathy or recurrent varicella bleeding, and meet other guidelines.
Neurological Disease
Neurological diseases such as coma, stroke, Parkinson’s disease and multiple sclerosis are life-altering conditions that can lead to permanent deterioration of the nervous system.
Oncology
In oncology, the biggest predictor of hospice eligibility is the patient’s functional status, which is determined by the Eastern Cooperative Oncology Group (ECOG) scale or the Palliative Performance Scale (PPS).
Renal Disease
More patients and families are choosing not to start or to withdraw dialysis for multiple reasons, particularly in patients older than 60 years.
Sepsis and Concomitant End-Stage Disease
Sepsis is one of the most deadly U.S. conditions, with about 250,000 deaths each year. The estimated annual cost of sepsis readmissions is more than $3.5 billion.
Palliative Care Guidelines
Consider a palliative care consultation for your patient if:
The care team, patient or family needs help with complex decision-making and determination of goals of care. Goals of care are derived when a medical professional has an open and guided discussion of:
- Uncertainty of prognosis
- Uncertainty of appropriateness of therapy options
- Uncertainty of end-of-life status and/or hospice appropriateness
Divergent views over care exist. Here are some scenarios:
- The patient and/or family request care that team feels is ineffective and probably has unsuccessful outcomes.
- There are conflicts over DNR orders.
- There’s recognition of limited therapeutic impact of artificial nutrition and hydration in a cognitively impaired, seriously ill or dying patient.
- Family distress is resulting in possible impaired surrogate decision-making.
There’s a presence of threshold situations that possibly predict of further decline:
- New diagnosis of life-limiting illness
- Declining function with decreased ability to complete activities of daily living
- Unrelenting, unexplained weight loss
- Hospital admission from long-term care facility
- These conditions are present:
- Metastatic cancer with failure of multiple regimens of treatment
- Neurologic complications of cancer
- Brain metastases
- Spinal cord compression
- Carcinomatous meningitis
- Advanced lung disease with frequent exacerbations
- Advanced cardiac disease requiring consideration of LVAD or IV pressors
- Advanced renal disease with deterioration despite dialysis
- Neurodegenerative disease considering feeding tubes or ventilator support
- Anoxic encephalopathy
- Stroke with resultant function decreased by 50 percent, considered life-limiting
- Catastrophic multiple trauma
- Continued use of a ventilator
