Criteria for Hospice

When to consider compassionate comfort care with Serenity Hospice Services:

  1. When the patient has been diagnosed with a life-limiting illness and curative treatment is  no longer necessary or desired
  2. When active treatment isn’t progressing
  3. When prognosis or life-expectancy is limited to 6 months or less
  4. When pain, shortness of breath, nausea or unresolved discomfort are present
  5. When family caregivers need support
  6. When the patient loses the desire to eat or the ability chew and to swallow
  7. When the patient becomes more dependent on caregivers with activities of daily living (ADL’s): bathing, dressing or walking without assistance
  8. When patient experiences acute behavior changes

Hospice care is available to individuals with a life-limiting illness experiencing at least one symptom under their disease process:

Basic Admission Criteria

  • Terminal illness with a prognosis of < 6 months or less should disease take its expected course
  • Decline in functional status as determined by:
    • Karnofsky Performance status of < 50%
    • Dependence in 3 out of 6 ADL’s
  • Multiple ER visits / inpatient hospitalizations in past 6 months
  • Weight loss of > 10% over prior 4-6 months
  • Serum Albumin level < 2.5gm/dl
  • Patient or caregiver has elected to receive no further curative measures
  • Documented clinical progression of disease

Neurological Disease (ES Alzheimers, ES Dementia)

  • Inability to ambulate w/o assistance
  • Inability to bathe or dress without assistance
  • Incontinent of bowel or bladder
  • Multiple decubitus ulcers, state III or IV
  • Frequent infections
  • Speech limited to ~ < 6 intelligible different words
  • At or beyond stage 7 of functional assessment
  • Hx of dysphagia
  • Weight loss of > 10% over prior 6 months
  • Serum albumin > 2.5gm/dl

AIDS

  • Antiviral therapy treatment failure
  • Wasting syndrome
  • Dementia
  • Leukoencephalopathies
  • Secondary malignancies (i.e. Kaposi’s lymphomas, leukemia’s and ES cervical cancer)
  • CD4 count below 25 cells/McL
  • Viral load > 100,000

ES Renal Disease

  • Creatinine clearance 10 cc/min (< 15 cc/min for diabetics)
  • Serum creatinine > 8.0 mg/dl (> 6.0 mg/dl for diabetics)
  • Urine output < 400 ml within 24 hours
  • Patient or family choose to d/c dialysis
  • Uremia

Cardiac Disease

  • Recurrent signs or symptoms of CHF
  • Unstable angina requiring opiates or nitrates for pain management
  • Symptoms of CHF or unstable angina present at rest
  • Frequent medication adjustments
  • Class IV functional status (NYHA): Inability to carry on any physical activity w/o discomfort
  • Ejection fraction of < 20%
  • Other co-morbid conditions: hx cardiac arrest & resuscitation, hx syncope, systolic b/p 120 mmHg, cardiogenic brain embolism, HIV disease

Pulmonary Disease

  • Disabling dyspnea at rest
  • Oxygen dependent
  • Increased ER visits or inpatient hospitialzations for infection or respiratory failure
  • Decrease in FEVI on serial testing of > 40 ml/yr
  • Presence of Cor Pulmonale or Rt. heart failure
  • Ejection fraction of < 25%
  • Weight loss of 10% over prior 6 months
  • Resting tachycardia > 100/min in patient with COPD
  • Hypoxemia at rest with oxygen
  • PO2 < 55 with oxygen, PCO2 > 50
  • Poor response to bronchodilators
  • O2 saturation < 88%

Cancer

  • DX confirmed thru pathology &/or radiology
  • Evidence of ES disease &/or metastasis
  • Recent lab or diagnostic studies to support disease progression

ES Liver disease

  • Documentation of specific liver disease
  • Severely impaired liver function, prothrombin time > 5 sec over control
  • Serum albumin < 2.5 gm/dl
  • Jaundice
  • Ascities
  • Edema
  • Hepatic encephalopathy
  • Recurrent variceal bleeding
  • Abnormal liver enzymes
  • Bleeding diathesis and elevated PTT

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