These are guidelines only; clinical judgment is required

• Unintentional progressive weight loss
• Curative treatment unlikely to improve quality or length of life
• The burden of treatment on the patient and family outweighs the potential benefits
• Metastasis to multiple sites
• Stage III b or Stage IV Metastatic disease
• Treatment refractory myeloproliferative disorders
• Continued decline despite disease directed treatments, or patient declines treatment

These are guidelines only; clinical judgment is required

• Shortness of breath at rest and with any activity
• Disabling dyspnea at rest, fatigue and cough from COPD, pulmonary fibrosis, or pulmonary HTN
• Hypoxemia at rest, right heart failure, resting or tachycardia
• Unintentional progressive weight loss
• Recurring respiratory infections
• Using multiple inhalers with poor response
• Increased need for assistance from bed to chair
• Fatigue and/or increased cough
• Repeated emergency room visits for pulmonary issues
• Unintentional weight loss
• O2 dependency changing

These are guidelines only; clinical judgment is required

Patients eligible or awaiting transplant may be considered for hospice care.

• Chest pain and/or shortness of breath with and without activity
• May have a history of MI, resuscitation, arrhythmias, embolic infractions, syncope, inoperable valvular heart disease, or CHF
• Treatment resistant angina or not a candidate for invasive revascularization procedures
• NYHA Class III or NYHA Class IV symptoms
• Fatigue, shortness of breath or functional decline
• Taking multiple cardiac medications or a poor response to medications
• Patient and/or physician believe heart surgery is not a preferred option
• Personal choice not to pursue any further specialized treatment
• Frequent ED visits or hospitalizations
• Cardiac arrest or syncope
• New dysrhythmia

These are guidelines only; clinical judgment is required

Patients eligible or awaiting transplant may be considered for hospice care.

• The patient is a transplant patient whose transplant has failed and the patient is not eligible for, or refuses, another transplant
• Sudden or progressive loss of functional independence
• Mainly sit or lie
• Confusion or cognitive impairment
• Bowel dysfunction
• Breathing difficulties
• Restlessness
• Albumin <2.5 gm/dl, INR >1.5
• Refractory ascites, Peritonitis, hepatorenal syndrome, or variceal bleeding

These are guidelines only; clinical judgment is required

• Cr clearance < 15 cc/min
• Creatinine > 8 mg/dl (or >6 if diabetic)
• Patient is not seeking dialysis, plans to discontinue dialysis, or can no longer tolerate dialysis
• Comorbidities support eligibility

These are guidelines only; clinical judgment is required

Includes: Alzheimer’s, senile dementia, Lewy Body, vascular and other dementias

• Continuing weight loss
• Needs help to sitting up, eating, getting dressed or grooming themselves
• Unable to walk without assistance, non-purposeful ambulation, or bed-bound
• Patient shows signs of severe anxiety
• Impaired speech, bowel and bladder incontinence
• Aspiration pneumonia, or recurrent UTIs
• Decubitus ulcers, or frequent falls

These are guidelines only; clinical judgment is required

• Must have established AIDS diagnosis
• Decision has been made to forego antiretroviral, antibacterial, antifungal, chemotherapeutic and prophylactic drug therapy related specifically to the AIDS diagnosis
• Chronic, persistent diarrhea
• Significant weight loss of 10% or more in past three months
• Generalized weakness
• CD4 count < 25 cells/mcL (or)
• Persistent viral load > 100,000 copies/ml (and)
• PPS < 50% with AIDS defining infection
• History of frequent opportunistic infections
• CHF at rest
• AIDS dementia complex
• Toxoplasmosis
• Generalized wasting