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Guidelines for Assessing
Hospice Appropriateness

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Cancer/Malignancy  End-Stage Cardiac Disease
End–Stage Dementia End-Stage AIDS  
End-Stage Renal Disease End-Stage Diabetes
End-Stage Pulmonary Disease End-Stage Liver Disease
End-Stage Cerebrovascular DiseaseGeneral Debility
End-Stage Neurological DiseaseComorbidity Conditions/Risk Factors



For all patients with a diagnosis of cancer, the following information should be obtained:

  1. Diagnosis confirmed through pathology or radiology
  2. Patient is no longer receiving, benefiting from or desiring curative treatment
  3. There is evidence of end-stage disease and/or metastasis
  4. Lab/diagnostic studies have been done recently to support disease progression
  5. Patients who are continuing to receive palliative radiation therapy or chemotherapy will be evaluated for admission on an individual basis  
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End–Stage Dementia  

  1. Dependency in all ADL’s
  2. Unable to effectively communicate with words
  3. Patient is chair or bed-bound
  4. Markedly decreased intake/weight loss
  5. Comorbid conditions (COPD, CHF, diabetes, neurologic/renal/liver disease)
  6. Recurrent infections (pneumonia, UTIs, septicemia, pressure ulcers)
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End-Stage Renal Disease  

  1. Creatinine > 8U/L
  2. 2.Discontinuing or refusing dialysis
  3. Chronic or acute illness that precipitated renal failure
  4. Urine output < 400mL/24hrs
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End-Stage Pulmonary Disease  

(COPD, Emphysema, Bronchitis, Cystic Fibrosis, Bronchiectasis, Pulmonary Fibrosis, Black Lung)

  1. No ventilatory support
  2. Poor response to multiple pulmonary medications
  3. O2 dependent
  4. Severe dyspnea at rest
  5. O2 saturation < or = 88%
  6. Presence of cor pulmonale
  7. Resting tachycardia > 100/min.
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End-Stage Cerebrovascular Disease  

  1. Dysphagia, aspiration
  2. Weight loss, albumin < 2.5 mg/dl
  3. Recurrent infections
  4. Karnofsky score < or = 4
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End-Stage Neurological Disease
Parkinson’s, Amyotrophic Lateral Sclerosis (ALS), Multiple Sclerosis (MS):  

  1. Dependency in all ADLs
  2. Recurrent infections
  3. Impaired respiratory functions/O2 dependent
  4. Has chosen not to receive ventilatory support
  5. Difficulty swallowing
  6. Weight loss
  7. Progressive decline in function over past 12 months
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End-Stage Cardiac Disease
The two main categories are:  

  1. Congestive Heart Failure or Cardiomyopathy with documented cardiomegaly on CXR
  2. Ischemic Heart Disease ASHD/ASCVD/CAD  

Class IV Symptoms:  

  1. Dyspnea or angina should be present for any cardiac disease
  2. Dyspnea and original symptoms at rest in spite of optimal medical therapy
  3. Discomfort with physical activity
  4. Multiple cardiac medications
  5. Abnormal EKG or ejection fraction < or = 20%
  6. Critical valvular lesions
  7. If CHF/Cardiomyopathy: evidence of fluid overload in spite of medications (edema, ascites, rales).
  8. If Ischemic Heart Disease/ASHD/ASCVD/CAD: history of refractory angina, arrhythmias, previous myocardial infarction or cardiac arrest
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End-Stage AIDS  

  1. CD4= count < 25 cells/mcL or viral load >100,000 copies/ml
  2. Patient is not receiving chemo, antiretrovirals or protease inhibitors other than for pain relief
  3. History of successive opportunistic infections
  4. CNS or systemic lymphoma
  5. Progressive multifocal leukoencephalopathy
  6. Visceral Kaposi’s sarcoma
  7. PPS score of 50% or less
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End-Stage Diabetes  

  1. History of insulin-dependent diabetes
  2. Severe vascular disease:  Cardiac: MI, angina, CHF  Cerebral: CVA  Peripheral: amputation, ulcers, severe hypertension
  3. Frequent infections
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End-Stage Liver Disease  

  1. Documentation of specific liver disease in history and physical
  2. Abnormal liver enzymes: alkaline phosphates, SGOT, and bilirubin
  3. Elevated BUN/creatinine
  4. Hepatic encephalopathy
  5. Ascites, peritonitis
  6. Albumin < 2.5 gm/dl
  7. Abnormal coagulation
  8. Hepatorenal syndrome
  9. Recurrent variceal bleeds
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General Debility  

  1. Weight loss within past 3 months (below ideal body weight)
  2. Bed-bound or chair-bound
  3. Comorbid conditions (COPD, CHF, diabetes, neurologic/renal/liver disease)
  4. Recurring infections (pneumonia, UTIs, septicemia, pressure ulcers)
  5. Increasing safety concerns (frequent falls)
  6. Worsening symptoms (pain, dyspnea, cough, N/V/D, edema, BP
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Comorbidity Conditions/Risk Factors  

  • Aspiration pneumonia
  • CAD
  • Liver disease
  • History of CVA
  • Hypertension/hypotension
  • Difficulty swallowing
  • Unintentional weight loss > 10% body weight
  • Diabetes, Renal disease
  • Refusal/inability to eat
  • Serum albumin < 2.5 mg/dl
  • Pyelonephritis
  • Stage 3-4 decubitus
  • CHF
  • COPD
  • Sepsis
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