When is it Time?

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Hospice care is for patients with a life-limiting illness who have chosen comfort care rather than curative treatment. Physicians must certify that the patient's life expectancy is six months or less, but that time frame is flexible. Services can extend beyond six months. Some people go on and off hospice care as their conditions change. Some people "graduate" from hospice because they get better.

It is time to consider hospice care when one or more of these circumstances apply:

  • Loss of function or physical decline;
  • Increase in hospitalizations;
  • Dependence in most activities of daily living;
  • Multiple diseases or conditions;
  • Increase in emergency room visits; and/or
  • Continuing weight loss.

In addition, each disease has its own criteria indicating hospice eligibility. Please contact us for more information.

CORE INDICATORS

  • Patient/family choose comfort care
  • Loss of function/physical decline
  • Increase in hospitalizations
  • Dependence in most activities of daily living
  • Multiple co-morbidities
  • Increase in ER visits
  • Weight loss

DISEASE-SPECIFIC INDICATORS

Amyotrophic Lateral Sclerosis

  • Unable to walk, needs assistance with ADLs
  • Barely intelligible speech
  • Difficulty swallowing
  • Weight loss
  • Significant dyspnea
  • Co-morbidities: pneumonia, URI

Cancer

  • Metastasis to multiple sites
  • Weight loss
  • Patient/family choose palliative care

Congestive Heart Failure

  • Class IV heart failure (symptoms at rest)
  • Ejection fraction less than or equal to 20% or diastolic dysfunction
  • Other cardiac symptoms, e.g. syncope, arrhythmias
  • Recurrent hospital/ER visits

Dementia

  • Steady weight loss AND/OR:
  • Needs help for all ADLs
  • Incontinence
  • Speaks few intelligible words
  • Needs help to sit up and hold up head

Failure to Thrive/Debility

  • Increasing need for help with ADLs
  • Steady weight loss

Liver Disease

  • Not a transplant candidate
  • Ascites despite maximum diuretics
  • Peritonitis
  • Hepatorenal syndrome
    Encephalopathy with somnolence, coma
  • Recurrent variceal bleeding

Pulmonary Disease - COPD

  • Dyspnea at rest
  • Poor response to bronchodilators
  • Recurrent pulmonary infections
  • Cor pulmonale/right heart failure
  • Weight loss
  • Resting tachycardia
  • Hypercapnia/hypoxemia

Renal Disease

  • Plan for discontinuing dialysis
    • rapidly declining in spite of dialysis
    • no renal transplant
  • Displays signs of uremia (confusion, nausea, pruritus, restlessness, pericarditis)
    Intractable fluid overload
  • Oliguria
  • Hyperkalemia

Stroke

  • Decline in function
  • Dysphagia with inability to take in adequate nutrition and no feeding tube planned.