Qualifying Conditions for Hospice Services

ALS
   Dyspnea at rest 
   Vital capacity less than 30% 
   Declines artificial ventilation 
   Critical nutritional impairment 
   Rapid disease progression or complications in past 12 months

Stroke 
   Patient is mainly in bed and requires significant assistance with self care 
   Poor nutritional status with weight loss over 10% in past 6 months or 7.5% in past 3 months 
   Serum albumin of less than 2.5 
   Coma with three of the following on third day of coma will support eligibility: 
      Abnormal brain stem response 
      Absent verbal responses 
      Absent withdrawal response to pain 
      Serum creatinine greater than 1.5

Renal Failure 
   Patient is not seeking or receiving dialysis 
   Creatinine clearance less than 10cc/dl (6.0mg/dl for diabetics) 
   Not a candidate for dialysis

Failure to Thrive 
   Palliative performance scale equal to or less than 40% 
   Mainly in bed, requires assistance with ADLs 
   Body mass index below 22 
   Patient declines or is not responding to nutritional support

Dementia 
  Inability to ambulate without personal assistance 
   Urinary and fecal incontinence, intermittent or constant 
   Speech is limited to a single intelligible word in a usual day 
   One of the following within the last 12 months 
      aspiration pneumonia 
      pyelonephritis or other UTI 
      Septicemia 
      Decubitus ulcers, multiple stage 3-4 
   Inability to maintain sufficient fluid and calorie intake 
   Fever recurrent after antibiotics

Cancer 
   Clinical finding of malignancy with widespread aggressive or metastatic disease 
   Patient no longer seeking curative treatment 
   Unable to do normal work because of the disease

Multiple Sclerosis 
   Critical nutritional impairment 
   Rapid disease progression or complications in past 12 months 
   Critically impaired breathing

Non-Specific Terminal Illness 
   Recent rapid clinical decline and disease progression 
   Recent decline to bed or bed-to-chair bound status and requires considerable assistance with self care 
   Weight loss 
   Dependence on assistance for two or more ADLs 
   Recurrent aspiration 
   Increase in ER visits, hospitalizations, or physician contact 
   Progression of cognitive impairment 
   Progressive pressure ulcers in spite of optimal care 
   Dysphagia with recurrent aspiration

Heart Disease 
   Poor response to optimal treatment with diuretics, vasodilators, or ace inhibitors 
   Presence of NYHA Class IV CHF or refractory angina 
   Ejection fraction less than 20% (helpful but not required) 
   Not a candidate for, or has declined revascularization procedures

Liver Disease 
   PT prolonged more than five seconds over control or INR greater than 1.5 
   Serum albumin less than 2.5gm/dl 
   Must have one of the following: 
      Ascites 
      Hepatic encephalopathy 
      History of recurrent variceal bleeding 
      Spontaneous bacterial peritonitis 
      Hepatorenal Syndrome

Pulmonary Disease 
   Decreased functional capacity 
   Evidence of disabling dyspnea at rest or with minimal exertion 
   Poor response to bronchodilators 
   Progression of disease as evidenced by increasing visits to the doctor, ER, and 
         hospital for pulmonary infections    
   Hypoxemia on room air less than 88% by oximetry 
   An FEV1 less than 30% (helpful but not required)

Parkinson’s Disease
   Critical nutritional impairment 
   Rapid disease progression or complications in the preceding 12 months

Patients are also eligible if they meet some of the criteria but have significant co-morbidities or rapid decline suggesting a six month or less progression. Even if the patient does not meet any of these conditions, they may still be eligible for hospice care if, in the judgment of the physician, the life expectancy is six months or less. Please call for an evaluation if you have any questions.