Disease-Specific Indicators
Patients suffering from chronic illnesses may be eligible for hospice care if one or more of the following indicators are present:
Amyotrophic Lateral Sclerosis
- Unable to walk, needs assistance with ADLs
- Barely intelligible speech
- Difficulty swallowing
- Weight loss
- Significant dyspnea
- Co-morbidities: pneumonia, URI
Cancer
- Metastases to multiple sites
- Weight loss
- Patient/family chooses palliative care
CVA
- 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
HIV/AIDS
- Wasting syndrome
- CNS lymphoma/Kaposi’s sarcoma
- AIDS dementia
- 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