Hospice Criteria

Disease Specific Criteria

  1. Cancer
    • Documentation of metastasis (lab or diagnostic test
    • No curative treatment / patient requesting palliative care
    • PPS less than 70% (Reduced ambulation, unable to do normal job or work, reduced food intake, some confusion)
  2. Cardiac Disease (Combined effects of the primary cardiopulmonary condition and any secondary conditions should be such that a beneficiary would have a prognosis of < 6 months if the disease continued its current decline.)
    • Dyspnea at rest with increase discomfort with minimal exertion. Inability to carry on any physical activity without increased discomfort (New York Heart Association Class IV)
    • PPS less than 60% (Reduced ambulation, unable to do hobbies or house work, need occasional assistance, reduced intake, some confusion)
    • Poor response to optimal treatment with diuretics and vasodilators
    • Decline invasive procedures
    • History of angina at rest, unresponsive to nitrate therapy, Ejection Fraction of < 20%, unexplained syncope, symptomatic arrhythmias, history of cardiac resuscitation
  3. Pulmonary Disease (Combined effects of the primary cardiopulmonary condition and any secondary conditions should be such that a beneficiary would have a prognosis of < 6 months if the disease continued its current decline.)
    • Disabling dyspnea at rest
    • Oxygen dependent O2 Sat < 88% or pO2 < 55mm/Hg
    • Hypercarbia – pCO2 > 50mm/Hg
    • Disease progression: multiple ER visits/hospitalizations
    • Poor/unresponsive to bronchodilators
    • Respiratory failure, Corpulmonal R/T pulmonary disease, Resting tachycardia
    • PPS < 50% (mainly sit/lie – bed to chair, can’t do any work, considerable assistance needed, reduced food intake, some confusion)
  4. Alzheimer’s Disease & Related Disorders
    • FAST Scale > 7A (Ability to speak six or fewer words in the course of the day or of an intensive interview, incontinent of bowel and bladder, unable to bathe, difficulty with ADLs, unable to ambulate without personal assistance)
    • Secondary conditions and comorbidities help define limitations: Pressure ulcers, UTI, Aspiration pneumonia, Dysphagia, Septicemia, recurrent fever post antibiotic therapy, COPD, CHF, CHD, etc.
  5. Liver Disease – Both I and II MUST be present, III Adds supporting information (Patients awaiting Liver Transplant, who otherwise meet above criteria, can qualify. If donor is procured, patient must be discharged.)
    • LAB: PT > 5 seconds over control or INR > 1.5 AND albumin < 2.5 gm/dl
    • End stage liver disease AND at least 1 of the following: Refractory ascites, Spontaneous bacterial peritonitis, hepatorenal syndrome (^ Bum/Creatinine with < 400 ml urine output/day and urine sodium < 10 mEq/1), Hepatic encephaloopathy refractory to treatment/non-compliance, recurrent variceal bleeding
    • Supporting factors: Progressive malnutrition, Muscle wasting with reduced strength and endurance, continued alcoholism (>80gm ethanol day, hepatocellular carcinoma, Hepatitis B, Hepatitis C refractory to interferon treatment,
    • Karnofsky < 60%
  6. Renal Disease – Specific structural/functional impairments and activity limitations should serve as the basis for palliative intervention
    • Refusal of dialysis
    • Creatinine clearance < 10 cc/min (<15 cc.ml for diabetics)
    • Creatinine > 8 mg/dl (>6 mg/dl for diabetics) [Supporting factors: Oliguria (400cc/day), Uremia, Hepatorenal syndrome, intractable hyperkalemia (>7.0), Karnofsky < 60%. Cormidities: Conditions precipitating renal disease: mechanical ventilation, malignancy of other organs, chronic lung disease, advance cardia disease, or liver disease.]
  7. Neurological Conditions – Identification of specific structural/functional impairments, together with any relevant activity limitations and comorbidities to support having a terminal illness with a life expectancy of 6 months or less.
    • Documentation of Structure of the nervous system, mental functions, sensory functions and pain, neuromusculoskeletal and movement related functions, communication, mobility and self-care that allow for a comprehensive description of health status and services needed
    • Documentation of structural/functional impairments and activity limitations facilitate selection of most appropriate intervention (palliative hospice vs. long-term disease management. *PPS/Karnofsky < 40% and FAST > 6 may help support functional limits*
  8. HIV – I. AND II. MUST be present. III adds supporting information
    • CD4+ Count < 25 cells/mcL or persistent viral load > 100,000 copies/ml and 1 of the following:
      • CNS lymphoma, wasting (<33% lean body mass), Mycobacterium Avium Complex bacteremia unresponsive to treatment/untreated/refused, Systemic lymphoma with HIV, Visceral Kaposi's sarcoma unresponsive to therapy, Renal failure - no dialysis, Cryptosporidium infection, Toxoplasmosis unresponsive to therapy
    • Karnofsky < 50%
    • Supporting information: Chronic persistent diarrhea for 1 year, Persistent albumin < 2.5gm/dl, age > 50 years old, absence of drug therapy for HIV disease, Advanced AIDS dementia complex, Toxoplasmosis, CHF with s/s at rest – NYHA class IV

Note: Although a patient may not meet exact criteria for a certain disease outlined above, comorbidities and functional decline may indicate a prognosis of less than six months. When in doubt a referral for evaluation for hospice care is in order.