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Hospice Eligibility Guidelines

When is it time to consider hospice care as an option?
It is time to consider hospice care when a patient exhibits one or more of the following core and/or disease-specific indicators:

One or more of the following:

  • Patient/family chooses comfort care
  • Loss of function/physical decline
  • Increase in hospitalizations
  • Dependence in most activities of daily living
  • Multiple co-morbidities
  • Increase in ER visits
  • Weight loss

Disease-specific indicators
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Amyotrophic Lateral Sclerosis

  • Unable to walk, needs assistance with ADLs
  • Barely intelligible speech
  • Difficulty swallowing
  • Weight loss
  • Significant dyspnea
  • Co-morbidities: pneumonia, URI


  • Metastases to multiple sites    
  • Weight loss
  • Patient/family chooses palliative care


  • Decreased level of consciousness, coma, or persistent vegetative state
  • Dysphagia
  • Post-stroke dementia
  • Decreased nutritional status (with or without artificial nutrition)
  • Co-morbidities

Dementia and/or General Decline

  • Unable to walk without assistance
  • Urinary and fecal incontinence
  • Speech limited to a few words
  • Unable to dress without assistance
  • Unable to sit up or hold head up
  • Complications: pneumonia, UTI, sepsis, pressure ulcers
  • Difficulty swallowing/eating
  • Weight loss

Heart Disease – CHF

  • NYHA Class III or IV
  • Discomfort with physical activity
  • Symptomatic despite maximal medical management
  • Arrhythmias resistant to treatment
  • History of cardiac arrest
  • Cardiogenic embolic CVA


  • Wasting Syndrome
  • CNS lymphoma/Kaposi's sarcoma
  • AIDS dementia
  • Hepatorenal syndrome
  • Decision to forego antiretrovirals
  • Co-morbidities/severe infection

Liver Disease

  • Typically INR >1.5; Serum albumin <2.5 gm/dl
  • Not a transplant candidate
  • Ascites despite maximum diuretics
  • Peritonitis
  • Hepatorenal syndrome
  • Encephalopathy with somnolence, coma
  • Recurrent variceal bleeding

Pulmonary Disease – COPD

  • Dyspnea at rest
  • Poor response to bronchodilators
  • Recurrent pulmonary infections
  • Cor pulmonale/right heart failure
  • Weight loss
  • Resting tachycardia
  • Hypercapnia/hypoxemia

Renal Disease

  • Plan for discontinuing dialysis
    • rapidly declining despite dialysis
  • Displays signs of uremia (confusion, nausea, pruritus, restlessness, pericarditis)
  • Intractable fluid overload
  • Oliguria
  • Hyperkalemia