Disease Management

Hospice manages symptoms that affect a patient’s quality of life, including but not limited to:

  • Significant pain or profound weakness; dyspnea
  • Nausea and/or vomiting
  • Emotional distress such as anxiety or grief
  • Spiritual or ethical issues related to the dying process
  • Multi-system deterioration

Select from the list below to learn more about each disease type and the indicators that a patient may be ready for hospice:

Cancer

Advanced cancer patients may be appropriate for hospice care if they have a prognosis of six months or less to live, should their illness run its natural course. A hospice assessment may be appropriate if a patient has experienced one or more of the following:

  • Disease with metastasis at presentation
  • Multiple symptoms and other disease involvement
  • Uncontrolled pain
  • Progression from early stage of disease to metastatic disease
  • Significant and/or unintentional weight loss
  • Symptoms that impede adequate nutrition such as dry mouth or dysphagia
  • Rapid fall in Palliative Performance Status in combination with other symptoms
  • Documented clinical decline over the past six months
  • Eastern Cooperative Oncology Group Performance Scale > 2
  • Frequent hospitalizations, office, or emergency department visits
  • Serum albumin < 2.5 gm/dl
  • Patient continues to decline in spite of definitive therapy

Heart Disease

End-stage cardiac disease patients may be appropriate for hospice care if they have a prognosis of six months or less to live, should their illness run its natural course. A hospice assessment may be appropriate if a patient has experienced one or more of the following:

  • Multiple hospitalizations for decompensation
  • Oxygen dependence
  • Ejection fraction < 20% New York Heart Association Class IV Failing while receiving optimal treatments Decrease in activities of daily living along with dyspnea at minimal exertion or rest Symptomatic despite standard therapies. Not a candidate for, or declines, invasive procedures such as coronary artery bypass surgery (CABG)
  • Co-morbid factors such as history of cardiac arrest, or age > 75 years
  • Laboratory studies documenting clinical decline
  • Documented clinical decline over the past six months

Renal Disease

End-stage renal disease patients may be appropriate for hospice care if they have a prognosis of six months or less to live, should their illness run its natural course. A hospice assessment may be appropriate if a patient has experienced one or more of the following:

  • Meets criteria for dialysis or renal transplant but refuses
  • On dialysis and chooses to discontinue dialysis
  • Creatinine clearance < 10 cc/min (< 15 cc/min for diabetes) Serum creatinine > 8 mg/dl (>6 mg/dl for Diabetes)
  • Co-morbid conditions
  • Needs significant assistance with ADL’s
  • Documented clinical decline including worsening lab results over the past six months

Lung Disease (COPD)

End-stage pulmonary disease patients may be appropriate for hospice care if they have a prognosis of six months or less to live, should their illness run its natural course. A hospice assessment may be appropriate if a patient has experienced one or more of the following:

  • Increased visits to the ED or hospitalizations for pulmonary infections and/or respiratory failure
  • Disabling dyspnea resulting in progressive inability, or struggle with ADL’s
  • Little or no response to bronchodilators
  • Recurrent episodes of bronchitis or pneumonia
  • Significant, unintentional weight loss
  • Laboratory studies documenting clinical decline
  • Documented clinical decline over the past six months
  • Palliative Performance Score < 40%

Alzheimer’s Disease

Advanced dementia patients may be appropriate for hospice care if they have a prognosis of six months or less to live, should their illness run its natural course. A hospice assessment may be appropriate if a patient has experienced one or more of the following:

  • Needs significant assistance with activities of daily living, such as dressing, bathing & ambulation
  • Urinary or fecal incontinence – intermittent or constant
  • No meaningful verbal communication
  • Additional factors may include pressure ulcers, increased falls, urinary tract infections (UTI), unintentional weight loss, or dysphagia Frequent hospitalizations, office, or emergency department visits Multiple co-morbidities<

Neurological Disease

End-stage neurological disease patients may be appropriate for hospice care if they have a prognosis of six months or less to live, should their illness run its natural course. A hospice assessment may be appropriate if a patient has experienced one or more of the following:

  • Stroke / Coma Degree of ambulation / mainly in bed
  • Unable to perform self-care
  • Inability to maintain hydration and caloric intake
  • Significant, unintentional weight loss
  • Progressive clinical decline
  • **Indicators above also apply to ALS and other debilitating neurological diseases
  • ALS (Amyotrophic Lateral Scelerosis) and other motor neuron diseases such as Parkinson’s Disease and Multiple Sclerosis Rapid progression of ALS and other motor neuron diseases
  • Critically impaired ventilator capacity
  • Critical nutritional impairment
  • Co-morbid conditions

Liver Failure

End-stage liver disease patients may be appropriate for hospice care if they have a prognosis of six months or less to live, should their illness run its natural course. A hospice assessment may be appropriate if a patient has experienced one or more of the following:

  • Progressive malnutrition; significant unintentional weight loss Continued active alcoholism (>80 gm ethanol / day)
  • Recurrent variceal bleeding (despite intensive therapy)
  • Spontaneous bacterial peritonitis
  • Refractory to treatment, ascites, or patient non-compliant
  • Hepatitis B positive
  • Hepatocellular carcinoma
  • Documented clinical decline, including labs, over the past six months
  • Palliative Performance Scale <40%
  • Requires assistance with three or more ADL’s
  • Frequent hospitalizations, office, or emergency department visits
  • Multiple co-morbities

Back to Top