Admission to hospice care requires a physician’s certification estimating that a person’s life expectancy is six (6) months or less if a terminal illness runs its normal course. Recognizing that the determination of life expectancy under these circumstances is difficult, the prediction criteria may change over time as research becomes available.
Heart Disease:
Primary Factors
- Symptoms of recurrent heart failure, angina at rest, discomfort with any activity (NYHA Class IV);
- Patients already optimally treated with diuretics and vasodilators (e.g., angiotensin-converting enzyme inhibitors);
- Ejection fraction equal or less than 20%;
- Symptomatic arrhythmias;
- History of cardiac arrest and CP
Pulmonary Disease:
Primary Factors
- Disabling dyspnea at rest;
- Progressive pulmonary disease (e.g., increasing ER visits or hospitalizations for pulmonary infections and/or respiratory failure);
- Hypoxemia at rest on supplemental O2
- PO less than or equal to 55mm Hg on supplemental O2
- PO2 saturation less than or equal to 88% on supplemental O2
- Hypercapnia with PCO2 greater than or equal to 50 mm Hg
Dementia:
- Severity of dementia greater than or equal to FAST stage 7C
- Unable to walk, bathe or dress without assistance;
- Urinary or fecal incontinence;
- Unable to speak more than six intelligible words per day;
- Severe comorbid conditions within the past six months;
- Aspiration pneumonia;
- Pyelonephritis;
- Septicemia;
- Multiple progressive stage 3-4 decubiti;
- Fever after antibiotics;
- Unable to maintain liquid/caloric intake to sustain life;
If feeding tube in place, weight loss > 10% in six months or serum albumin < 2.5g/dl liver disease: end stage cirrhosis; not a candidate for liver transplant; prothrombin time >5 sec over control or INR > 1.5 and serum albumin < 2.5 g/dl; at least one of the following: ascites despite diuretics and low sodium diet; spontaneous bacterial peritonitis; hepatorenal syndrome; hepatic encephalopathy despite treatment; recurrent variceal bleed; renal disease: chronic renal failure: coming off of or not a candidate for dialysis (creatinine clearance 15 cc/min); and serum creatinine > 8.0 mg/dl (for diabetes . 6.0 mg/dl).
Uremia: nausea, pruritus, confusion or restlessness;
Oliguria: output < 400 cc/ 24 hours; uremic pericarditis; hepatorenal syndrome; stroke and coma: acute phase following CVA coma or persistent vegetative state > 3 days;
Any one of the following on day 3 for coma:
- Abnormal brain stem response
- Absent verbal response
- Absent withdrawal to pain stimulus
- serum creatinine> 1.5 gm/dl
- chronic phase of CVA
Any one of the following:
Age> 70 years
Post stroke dementia FAST score >7 ( unable to toilet, dress, or bathe without assistance; unable to speak more than six different intelligible words per day; and occasional urinary or fecal incontinence)
Karnofsky less than or equal to 50%
