Criteria for hospice care

End-of-life care gives the patient/family the right to be in control of their lives, to be free of pain, and to die with dignity in the comfort of their home surrounded by their family and friends.

Making the decision

The physician certifies that if the disease process takes its normal course, the prognosis is approximately six months. The patient at this time is no longer seeking aggressive treatment. The registered nurse and the physician assess the patients’ medical needs and develop, with team members, a plan of care to best meet the physical, emotional, and spiritual needs of the patient/family.

Indicators for Hospice Eligibility

ALS

- Significant Dyspnea at rest

- Vital capacity less than 30%

- Requirement for supplemental oxygen at rest

- Declines artificial ventilation

- Critical nutritional impairment

- Rapid disease progression with either nutritional impairment or life threatening complications

 

CANCER

- Clinical findings of maligancy with widespread, aggressive, or etastatic disease

- Patient no longer seeking curative treatment

- Patient can only pursue normal activities with effort

 

CHRONIC DEGENERATIVE NEUROLOGIC DISEASE (includes Muscular Dystrophy, Myasthenia Gravis, Multiple Sclerosis, Parkinson's Disease, and Huntington's Disease)

- Critically impaired breathing, OR

- Rapid disease progression or life threatening complications in the preceding 12 months AND

- Critical nutritional impairment or life threatening complications

 

DEMENTIA

- Inability to amputate or dress without personal assistance

- Urinary and fecal incontinence, intermittent or constant

- No meaningful verbal communication, stereotypical phrases only, or ability to speak is limited to six or fewer intelligible words.

 

FAILURE TO THRIVE

- Palliative Performance Scale equal to or < 40% (mainly in bed, requires assistance with ADLs)

- The paitent declines or is not responding to enteral or parenteral nutritional support

 

HEART DISEASE

- Classified as having NYHA Class IV CHF symptoms AND

- Poor response to optional treatment with diuretics vasodilators, or ace inhibitors or angina pectons at rest resistance to standard nitrate therapy OR

- Not a candidate for, or has declined, invasive procedures

- Ejection fraction < 20% (helpful but not required)

 

LIVER DISEASE

- Patient prolonged more than five seconds ove control or INF > 1.5

- Serum albumn less than 2.5gm/dl

- Must have one of the following: Ascites, Hepatic endephaiopathy, history of recurrent variceal bleeding, spontaneous bacterial peritonitis, Hepatorenal Syndrome

HIV/AIDS

- CD4+ count <25 cells/mcL OR persistent viral load > 100.000 copies/mi from two or more assays at least one month apart AND

- Requires considerable assistance and frequent medical care, activity limited mostly to bed or chair AND

- One of the following conditions:

  - CNS lmphoma

  - Loss of > 33% lean body mass

  - MAC bacteremia, untreated, refractory, or treatment refused

  - Progressive multifocal leukoencepnalopathy

  - Systemic lymphoma

  - Refractory visceral Kaposi's sarcoma

  - Renal failure in the absence of dialysis

  - Refractory cryptosporidium infection

  - Refractory toxoplasmosis

 

NON-SPECIFIC TERMINAL ILLNESS

- Recent rapid clinical decline and disease progression

- Recent decline to bed or bed-to-chair existence and requiresconsiderable assistance with self care

- Recent significant weight loss

- Decline is not attributable to a known primary disease process

- Increase in ER visits, hospitalizations, or physician contact

- Progression of cognitive impairment

- Progression pressure ulcers in spite of optimal care

- Dysphagia with recurrent aspiration

 

PULMONARY DISEASE

- Decreased functional capacity (bed-to-char existence and requires considerable assistance with self-care)

- Evidence of disabling dyspnea at rest, or with minimal exertion

- Poor response to bronchodilators

- Progression of disease as evidenced by increasing visits to physician, ER, or hospital for pulmonary infections

- Hypoxemia with PO2<=55 or 02 sat<=88 on supplemental oxygen

- Hypercapnia with PCO2>=50

- An FEVI <30% (helpful but not required)

 

RENAL FAILURE

- Patient is not seeking dialysis or transplant

- Creatinine clearance less that 10cc/min (<15oc/min for diabetics)

- Serum creatinine > 8.0mg/dl (>6.0mg/dl for diabetics)

 

STROKE OR COMA

- Patient is mainly in bed and requires significant assistance with all ADLs

- Poor nutritional status with weight loss ~ 10% in the past six months or 7.5 in the past three months

- Serum albumin of < 2.5

 

Contact Us

Community Hospice

3600 Chestnut Street
New Orleans, LA 70115

 

Phone: 504-899-2011

 

Email: info@communityhospice.us

 

Or use our contact form.

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