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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