Hospice Admission Guidelines
Two or more items in any category should generate a hospice referral.
Please call our Referral Center at 888-287-1255 or fill out our secure online referral form for healthcare professionals.
General Guidelines
- Life-limiting condition
- Patient/family focus on symptom relief rather than cure
- Progression of disease(s)
- Evidence of weight loss; serum albumin < 2.5g/dl
- Symptoms & signs that paint a picture of decline
- Karnofsky or Palliative Performance Scale score < 50%
- Dependence in at least 2 ADLs
- Need for frequent hospitalization, office or ER visits
- Progressive/unhealing stage III or IV pressure ulcers
Cancer
- Clinical findings of malignancy with widespread, aggressive or progressive disease as evidenced by increasing symptoms, worsening lab values and/or evidence of metastatic disease
- Impaired performance on Palliative Performance Scale of <70%
- Refuses further curative therapy or continues to decline despite definitive therapy. Decline evidenced by:
- Hypercalcemia > or = 12
- Cachexia or weight loss of 5% in the preceding 3 months
- Recurrent disease after surgery/radiation/chemotherapy
- Refusal to pursue additional curative or prolonging cancer treatment
- Signs and symptoms of adcanced diesease (nausea, anemia, malignant ascites or pleural effusion, etc.)
Pulmonary Disease
- Severe chronic lung disease
- Disabling dyspnea at rest, poorly responsive to bronchodilators
- FEV1 after bronchodilator < 30%
- Progression of end-stage pulmonary disease
- Recurrent pulmonary infections
- Hypoxemia at rest, on room air: pO2 < 55mmHg - or O2 sat < 88%
- Right heart failure secondary to pulmonary disease
- Unintentional progressive weight loss >10%
- Persistent resting tachycardia
Stroke and Coma
- Karnofsky Performance < 40%
- Inability to maintain nutrition/hydration
- Weight loss > 10%, serum albumin < 2.5 gm/dl, pulmonary
- aspiration, severe dysphagia
- Coma with any 3 of the following on day 3 of coma
- Abnormal brain stem response
- Absent verbal response
- Absent withdrawal response to pain
- Serum creatinine > 1.5 mg/dl
Cardiac Disease
- Symptomatic despite optimal treatment with diuretics and vasodilators
- Recurrent CHF
- Ejection fraction < 20%
- New York Heart Association Class IV
- Supporting factors
- Arrhythmias are resistant to treatment
- History of cardiac arrest or resuscitation
- History of unexplained syncope
- Cardiogenic embolic disease (e.g., CVA)
Renal Disease – Acute Renal Failure
- Patient is not seeking dialysis or transplant
- Creatinine > 8mg/dl (> 6mg/dl for diabetics)
- GFR < 10ml/min
- Creatinine clearance <10cc/min (<15cc/min for diabetics)
- Co-morbid conditions
Renal Disease – Chronic Renal Failure
- Patient is not seeking dialysis or transplant
- Creatinine clearance <10cc/min (<15cc/min for diabetics)
- Creatinine > 8mg/dl (> 6mg/dl for diabetics); GFR < 10ml/min
- Symptoms: uremia; oliguria; confusion; nausea; vomiting; pruritus; restlessness; hyperkalemia > 7.0, not responsive to treatment; intractable fluid overload, not responsive to treatment
Liver Disease
- PTT > 5 seconds over control
- Serum Albumin < 2.5gm/dl
- End-stage liver disease
- Ascites refractory to treatment
- Spontaneous bacterial peritonitis
- Hepatorenal syndrome
- Hepatic encephalopathy, refractory to treatment
- Supportive factors
- Progressive malnutrition
- Continued alcoholism
- Hepatocellular carcinoma
Dementia
- Functional Assessment score = 7
- Unable to ambulate without assist
- Unable to dress or bathe without assist
- Urinary and fecal incontinence, intermittent or constant
- No consistently meaningful verbal communication
- Complications such as aspiration pneumonia, UTI, septicemia, recurrent fevers
- Decubitus ulcers stage 3 or 4
- Weight loss of >10% over last six months
ALS
- Critically impaired respiratory function
- Dyspnea at rest
- Use of accessory muscles
- Respiratory rate > 20
- Reduced speech / vocal volume
- Unexplained headaches, anxiety or nausea
- Severe nutritional insufficiency
- Progressive weight loss of at least 5% of body weight
- With or without gastrostomy tube insertion
HIV
- CD4 count < 25 cells/mcl or persistent viral load >100,000 copies/ml
- Decreased performance status
- Supporting factors
- Chronic persistent diarrhea
- Persistent serum albumin < 2.5
- Concomitant substance abuse
- Age > 50
- Advanced AIDS dementia complex
- CHF or advanced liver disease
Source: Current CMS and NHPCO guidelines