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Hospice Eligibility Guidelines

The first step in evaluating whether a patient with a life-limiting illness is appropriate for hospice care is determining that the patient prefers hospice and palliative care over curative treatment. In addition, a patient will likely have one or more of the following indicators present:

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

A community or hospice physician must certify that the patient’s prognosis is six months or less if the disease runs its normal course. Hospice care can be extended beyond six months as long as the patient continues meeting eligibility criteria.

Disease-specific eligibility 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

Cancer

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

CVA and Coma

  • Decreased level of consciousness, coma, or persistent vegetative state
  • Dysphagia
  • Paralysis
  • Post-stroke dementia
  • Decreased nutritional status (despite artificial nutrition)
  • Co-morbidities

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

 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

Liver Disease

  • 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
    • no renal transplant
  • Displays signs of uremia (confusion, nausea, pruritus, restlessness, pericarditis)
  • Intractable fluid overload
  • Oliguria
  • Hyperkalemia

 

Going Home

By Ken Schepel, HOV Chaplain

José was fully lucid and prepared to die. He was in poor health, sustained by a ventilator.

He wanted to die with his family around him outdoors since he spent his life on a farm and ranch in the West Valley.

West Valley Hospital was willing to extubate, but could not accommodate José’s request to die outdoors in the presence of his extended family.

Enter Hospice of the Valley. José, 89, had been on our service nine years earlier for debility and was discharged when he improved. When he reconnected with HOV on March 26, 2013, within 24 hours, team members throughout the agency worked together to make his wish come true.

Admissions Coordinator Darcy Douglas began a readmission at the hospital and contacted team leader Barbara Carter at Surprise PCU to make transfer arrangements.

CNAs Carley Crain and Toni Kimber prepared a room that opened onto an outdoor patio area that would accommodate Jose’s family, who gathered there to wait.

They requested a chaplain and Ken Schepel obliged. Nurse practitioner Lisa Reda was there to conduct a face-to-face exam upon readmission. When José arrived with his wife Mary, he was alert, aware and at peace. His bed was rolled onto the patio.

José looked with recognition at his family and with understanding to the staff. The extubation was begun by RNs Danette Sanetra and Teresa Cooley. With songs and prayers led by Ken, and with four generations of family nearby, José passed peacefully within the half hour.

A team effort came together in a beautiful way on that Tuesday at sunset in Surprise.

© 2013 Hospice of the Valley