When to Choose Hospice Care

Hospice is a choice when curative treatments are no longer being sought, and the patient chooses to focus on comfort care and medical management of symptoms. Learn more about when it may be time to choose hospice care.

Identification of Hospice Appropriate Patients

  • Patient not eating or drinking well enough to sustain weight
  • Weight loss of 10% or more in 6 months or less
  • Recurrent infections in last 6 months
  • Frequent hospitalizations in last 6 months
  • Patient or family refuses PEG placement(patients with existing PEG tubes can be accepted)
  • Patient refuses hospitalization or other aggressive treatments
  • Patient has optimal treatment, but continues to exacerbate
  • Significant decline in overall health due to multiple medical and functional problems

Guidelines for Non-Cancer Diagnoses:

These guidelines are not meant to be inclusive.  They are examples of criteria requirements set forth by the National Hospice Organization.  A consultation would be necessary to make a definitive determination regarding hospice appropriateness.

End-Stage Cardiovascular Disease

  • Recurrent, persistent symptoms of CHF despite optimal/maximal treatments, including optimal therapy with diuretics and ACE inhibitors.
  • Recent episode of cardiac arrest, syncope, respiratory arrest
  • May or may not be oxygen dependent
  • Multiple hospitalizations related to a severe cardiac condition
  • Inability to perform physical activity of any kind without discomfort, pain, or shortness of breath.
  • CVA of cardiac origin, such as an embolism
  • Ejection Fraction of <20%
  • Unstable weight
  • Uncontrolled edema

End-Stage Pulmonary Disease

  • Dyspnea at rest
  • Functional activity is limited so much that patient experiences a “bed-to-chair” existence, disabling dyspnea
  • Signs of right-sided heart failure
  • FEV1<30% of predicted value, post bronchodilator therapy
  • Multiple ER visits/hospitalizations for pulmonary infections or failure
  • Weight loss of greater than 10% of body weight in last 3-6 months
  • Hypoxemia at rest (02 Sat<88% on room air)
  • Frequent steroid and/or antibiotic use
  • Resting pulse rate >100 beats/min
  • Progressive cough and fatigue
  • Previous requirements of ventilator secondary to respiratory failure/infection

End-Stage Renal Disease

  • Candidate for Dialysis, but refuses
  • Stops dialysis to choose palliative care
  • Creatinine clearance <10ml/min (<15ml/min if diabetic)
  • Serum creatinine > 8.0mg/dl (>6.0mg/dl if diabetic)
  • Hepatorenal Syndrome
  • Uremia

End-Stage Liver Disease

  • Prothrombin time >5 seconds over control and Serum Albumin <2.5mg/dl, with at least one of the following:
  • Recurrent bleeding or esophageal varices
  • Ascites
  • Hepatorenal syndrome (as evidenced by elevated BUN and Creatinine
  • Hepatic encephalopathy and/or coma (very late stage)

End-Stage HIV Disease

  • Chronic persistent diarrhea for one year, regardless of etiology
  • Persistent serum albumin <2.5 g/dl
  • Concomitant substance abuse
  • Decisions to forego antiretroviral, chemotherapeutic, and prophylactic drug therapy related specifically to HIV disease
  • Congestive heart failure, symptomatic at rest
  • CD4+ count below 25 cells/mcl
  • Persistent HIV RNA (Viral load) of >100,000 copies/ml
  • Opportunistic disease such as CNS lymphoma, progressive multifocal leukoencephalopathy, cryptosporidiosis, wasting, MAC bactermia, visceral Kasposi’s sarcoma renal failure, AIDS dementia complex or toxoplasmosis.

End-Stage ALS (Amyotrophic Lateral Sclerosis)

  • Rapid progression of ALS in last six months, as evidenced by: progression from ambulation or wheelchair to being bed bound, from normal to pureed diet, from independent or partial-assist to total assistance with ADL’s, no longer speaks intelligibly.
  • Must exhibit one of the following: Impaired breathing ability as evidenced by respiratory infections or failure, nutritional impairment responsible for >10% loss of body weight in <6 mos., or life-threatening complications like pneumonia, urosepsis, etc.

End-Stage Dementia; Alzheimer’s/Multi-infarct

  • Exhibits all the following: Unable to ambulate, dress, or bathe without assistance; unable to converse meaningfully with others, incontinent of urine and stool.
  • Cannot sit upright in geri-chair or wheelchair without support
  • Difficulty swallowing food, liquids, or medications
  • No longer smiling or interacting with caregivers
  • History of frequent UTI’s urosepsis, pneumonia, septicemia
  • Multiple decubiti
  • Weight loss

End-Stage Stroke, CVA

  • Dysphagia may or may not be a candidate for artificial nutrition/hydration
  • Age >70 years
  • Greater than 10% weight loss despite enteral feeding
  • Comorbid conditions such as aspiration, pneumonia, multiple decubiti, septicemia, urosepsis, or frequent UTI’s
  • Unable to communicate meaningfully

General Debility

  • Progressive weight loss of >10% of body weight in <6mos
  • Poor appetite, anorexia, cachexia
  • Medical intervention is believed to be futile (e.g. secondary to advanced age, malnutrition, etc.)
  • Multiple hospitalizations and/or infections
  • Co-morbid conditions