Hospice Criteria

Identification of Hospice Appropriate Patients
  • Patient has a life limiting illness with prognosis measured in months
  • Weight loss of 10% or more in six months or less
  • Recurrent infections in last six months
  • Frequent hospitalizations in last six months
  • Patient or family refuses PEG placement
  • Patient refuses hospitalization or other aggressive treatments
  • Patient has optimal treatment, but continues to exacerbate
  • Significant decline in overall health due to multiple medical and functional problems
Guidelines for Non-Cancer Diagnoses

These guidelines are not meant to be inclusive. They are examples of criteria requirements set forth by the National Hospice Organization. A consultation would be necessary to make a definitive determination regarding hospice appropriateness.

End-Stage Cardiovascular Disease
  • Recurrent, persistent symptoms of CHF despite optimal/maximal treatments, including optimal therapy with diuretics and ACE inhibitors.
  • Recent episode of cardiac arrest, syncope, respiratory arrest
  • May or may not be oxygen dependent
  • Multiple hospitalizations related to a severe cardiac condition
  • Inability to perform physical activity of any kind without discomfort, pain, or shortness of breath
  • CVA if cardiac origin, such as an embolism
  • Ejection Fraction of <20%
  • Unstable weight
  • Uncontrolled edema
End-Stage Pulmonary Disease
  • Dyspnea at rest
  • Functional activity is limited so much that patient experiences a “bed-to-chair” existence, disabling dyspnea
  • Signs of right-sided heart failure
  • FEVI<30% of predicted value, post bronchodilator therapy
  • Multiple ER visits/hospitalizations for pulmonary infections or failure
  • Weight loss greater than 10% of body weight in last 3-6 months
  • Hypoxemia at rest (02 Sat<88% on room air)
  • Frequent steroid and/or antibiotic use
  • Resting pulse rate > 100 beats/min
  • Progressive cough and fatigue
  • Previous requirement of a ventilator secondary to respiratory failure/infection
End-Stage Renal Disease
  • Candidate for dialysis, but refuses
  • Stops dialysis to choose palliative care
  • Creatinine clearance <10ml/min (<15ml/min if diabetic)
  • Serum creatinine > 8.0mg/dl (>6.0mg/dl if diabetic)
  • Hepatorenal Syndrome
  • Uremia
  • Oliguria (UO <400ml/24 hrs)
  • Intractable hyperkalemia (>7.0) not responsive to treatment
End-Stage Liver Disease
  • Prothrombin time >5 seconds over control and serum albumin <2.5 mg/dl, with at least one of the following:
  • Recurrent bleeding or esophageal varices
  • Ascites
  • Hepatorenal syndrome (as evidenced by elevated BUN and Creatinine)
  • Hepatic encephalopathy and/or coma (very late stage)
End-Stage HIV Disease
  • Chronic persistent diarrhea for one year, regardless of etiology
  • Persistent serum albumin <2.5g/dl
  • Concomitant substance abuse
  • Decisions to forego antiretroviral, chemotherapeutic, and prophylactic drug therapy related specifically to HIV disease
  • Congestive heart failure, symptomatic at rest
  • CD4+ count below 25 cells/mcl
  • Persistent HIV RNA (Viral load) of >100,000 copies/ml
  • Opportunistic diseases such as CNS lymphoma, progressive multifocal leaukoencephalopathy, cryptosporidiosis, wasting, MAC bacteremia, visceral Kaposi’s sarcoma, renal failure, AIDS dementia complex or toxoplasmosis.
End-Stage ALS (Amyotrophic Lateral Sclerosis)
  • Rapid progression of ALS in last six months, as evidenced by: progression from ambulation or wheelchair to being bed bound, from normal to pureed diet, from independent or partial-assist to total assistance with ADL’s, no longer speaks intelligibly.
  • Must exhibit one of the following: Impaired breathing ability as evidenced by respiratory infections or failure, nutritional impairment responsible for >10% loss of body weight in <6 months, or life-threatening complications like pneumonia, urosepsis, etc.
End-Stage Dementia; Alzheimer’s/Multi-Infarct
  • Exhibits all the following: Unable to ambulate, dress, or bathe without assistance; unable to converse meaningfully with others, incontinent of urine and stool.
  • Cannot sit upright in geri-chair or wheelchair without support
  • Difficulty swallowing food, liquids or medications
  • No longer smiling or interacting with caregivers
  • History of frequent UTI’s, urosepsis, pneumonia, septicemia
  • Multiple decubiti
  • Weight Loss
End-Stage Stroke, CVA
  • Dysphagia may or may not be a candidate for artificial nutrition/hydration
  • Age >70 years
  • Greater than 10% weight loss despite enteral feeding
  • Comorbid conditions such as aspiration pneumonia, multiple decubiti, septicemia, urosepsis, or frequent UTI’s
  • Unable to communicate meaningfully
General Debility
  • Progressive weight loss of >10% of body weight in <6 months
  • Poor appetite, anorexia, cachexia
  • Medical intervention is believed to be futile (e.g. secondary to advanced age, malnutrition, etc.)
  • Multiple hospitalizations and/or infections
  • Comorbid conditions