Guidelines for Identification of Potential Hospice Patients

Evaluations of potential hospice patients are always done with a physician's order in place.

Terminal illness, as defined by a life expectancy of six months or less, may be difficult to identify in patients with debilitating, chronic illness. Potential candidates may be identified first by diagnosis. Following this identification a determination must be made regarding:
  1. Reduction in activities of daily living (ADLs), which may indicate a limited life expectancy based on the use of Karnofsky Performance Scale.
  2. Lack of response to therapy for acute exacerbation of chronic illness.
  3. Quality of life, as assessed by the patient and/or the family.
  4. Determination by the patient, family representing the patient or person with power of attorney that further curative measures of therapies are to be withheld.
Common Hospice Diagnosis include:
  • Malignancy (Cancer, Leukemia, Myeloma)
    End Stage Non-Cancer Diagnoses & Comorbidities:
  •     Stroke, Coma
  • Amyotropic Lateral Sclerosis (ALS)
  • Parkinson's Disease
  • Dementia (Alzheimer's, Multi-infarct)
  • End Stage Pulmonary Disease
  • End Stage Renal Disease
  • End Stage Hepatic Disease (Cirrhosis)
  • End Stage HIV infection (AIDS)
  • Multi-system failure with failure to thrive
  • End Stage Heart Disease
  • Debility
  • Cachexia
  • Multiple Stage III & Stage IV Decubitus
  • Hepatitis B & C
  • Peripheral Vascular Disease (PVD) with Gangrene.
Note: Diagnosis alone may not be sufficient to classify a patient as a candidate for hospice care. Lack of response to treatment, situation in that the disadvantages of treatment outweigh the potential benefits, and situations where further active treatments that prolongs the process of dying are rejected by the patient's responsible party must be taken into consideration.

Specific Criteria for the General Hospice Population:
  1. The patient understands his/her diagnosis.
  2. The patient understands all therapeutic options available to him/her.
  3. The patient/family have decided against active treatments for cure, reverse or stabilize the disease process.
  4. The patient has a consistent Karnofsky Performance Status of 60% or less (see below)
  5. The patient has had a weight loss of 10% of body mass in six weeks.
  6. The patient has exhibited decreased activity tolerance over the past 2-3 months.
  7. The patient has had a decreased appetite/nutritional intake over the past 2-3 months.
  8. The patient has had an observable and documented change in condition in the past 2-3 months.
  9. The patient has exhibited decreased cognitive abilities over the past 2-3 months.
  10. The patient has had greater than two documented infections that if now untreated with potentially curative therapies, would become life threatening.
  11. The patient needs personal assistance or is completely dependent for bathing, dressing, toileting, transfer, continence, and feeding.