Admission Criteria

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