General Guidelines for Hospice Admission
Lack of symptoms does not automatically disqualify hospice admission. Contact Roze Room to help evaluate and discuss your patients.
- Life-limiting condition with prognosis of six months or less if disease progression runs its normal course
- Patient/family informed that condition is life-limiting and have elected comfort care
- Frequent hospitalizations
- Decreased appetite
- Increasing weakness, fatigue, somnolence
- Alteration in cognitive and functional abilities
- Compromised ADLs
- Deteriorating mental abilities
- Recurrent infections
- Skin breakdown
- Specific decline in condition
Disease Criteria
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
Roze Room Hospice can also assist by visiting your patient in their home to determine if hospice is appropriate. If you have a patient who appears to be meeting any of these indications, an in-home assessment by one of our trained nurses may be informative. We are also available to help assist in the hospice conversation with a patient and their family.
