Hospice Medicine Foundation

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    Eligibility Criteria



    Criteria to determine if a patient may be eligible for hospice are not concrete for the most part. The following guidelines are utilized to determine eligibility to be admitted to hospice or to continue to remain on hospice.  Signs of clinical progress of a terminal disease and overall functional decline of a patient are the cornerstone of this determination and are essentially outlined through these sets of criteria.


    Hospice-Determining Terminal Status


    Clinical Variables (Listed below). No specific number needs to be met, but more wight given to the first 3 sets of criteria to predict a prognosis of 6 months or less.

    Alternatively,    Non-disease specific guidelines PLUS disease specific guidelines need to be met to determine eligibility for hospice.

    Presence of secondary diagnosis should be considered as they may increase the likelihood of prognosis of 6 months or less.

    I. Clinical Variables:
    1. Progression of disease based on clinical status, symptoms, signs, lab data:
      1. Clinical status
        1. recurrent or intractable infection (pneumonia, sepsis, UTI)
        2. progressive inanition documented as
          1. weight loss not due to reversible cause (depression, etc)
          2. decreasing mid-arm circumference, abdominal girth, not due to any reversible cause.
          3. decreasing serum albumin or cholesterol
        3. Dysphagia leading to recurrent aspirations and/or inadequate oral intake documented by decreasing food consumption
      2. Symptoms
        1. Dyspnea with increasing respiratory rate
        2. intractable cough
        3. Nausea/vomiting poorly responsive to therapy
        4. Diarrhea, intractable
        5. Pain requiring increasing doses of medications more than briefly
      3. Signs
        1. decrease in systolic BP below 90 or progressive postural hypotension
        2. ascites
        3. venous, arterial, lymphatic obstruction due to local progression or metastatic disease
        4. edema
        5. pleural or pericardial effusion
        6. weakness
        7. change in mental status
      4. Laboratory (if available)
        1. increasing PCO2, decreasing PO2 or saturation
        2. increasing calcium, creatinine or liver test
        3. increasing tumor markers
        4. progressive decline or increase in sodium or increasing potassium




    2. Decline in performance scales :Karnofsky Performance Status (KPS) or Palliative Performance Score (PPS) from 70% or less due to progression of disease.

    3. Increase ER visit, doctor visits, or hospitalization related to hospice diagnosis

    4. Progression on the FAST scale for dementia patients to greater than 7A.

    5. Progression on dependence of additional ADLs.

    6. Progressive stage 3-4 pressure ulcers despite adequate care.


    II. Non-disease Specific Baseline Guidelines:

    1. Karnofsky or PPS < 70%
    2. Dependence on at least 2 activities of daily living (ADL) - DEATTH -
      1. Dressing
      2. Eating
      3. Ambulating
      4. Transferring
      5. Toileting (incontinence)
      6. Hygiene (bathing)




    Comorbidies that may contribute to prognosis of less than 6 months if present
    • COPD
    • CHF
    • IHD
    • Diabetes Mellitus
    • Neurologic Disease (CVA, ALS, MS, Parkinsons)
    • Renal Failure
    • Liver disease
    • Neoplasia, Cancer
    • AIDS
    • Dementia


     Click here for additional Reference for Hospice Eligibility Criteria. 







    Hospice Determining Status

      




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