Patient Eligibility
for Hospice Care

A Guide For High-Risk Hospital Readmissions

 

Patient Eligibility for Hospice Care | HOPE Healthcare and Hospice

Prevent High-Risk Hospital Readmissions

Hospice care is a valuable resource for healthcare workers who are looking to prevent high-risk hospital readmissions. It's important that healthcare workers understand the special eligibility requirements needed when considering hospice services, such as age, diagnosis and prognosis criteria. 

By ensuring that patients are eligible for hospice care, healthcare professionals can reduce the burden on medical facilities. 

 

 

General Eligibility

Consider hospice if a patient meets two or more of these complications:

  • Dependence for 2+ of 6 ADLs
  • Multiple ER visits or hospitalizations
  • Albumin <2.5
  • SOB or fatigue at rest/minimal exertion
  • Recurrent falls
  • 10% weight loss in 6 months
  • Decreased tolerance in physical activity
 
 

Amyotrophic Lateral Sclerosis (ALS)

Patients will be considered to be in the terminal stage of ALS (life expectancy of six months or less) if they meet the following criteria. 

The patient declines mechanical ventilation; external ventilation is used for comfort measures only.
  • Patients should demonstrate critically impaired breathing capacity
  • Dysphasia 
  • Wheelchair or bed-bound status
  • Needs assistance in most or all (ADLs)

 

 

Alzheimer's and Other Dementias

Consider hospice if a patient meets two or more of these complications:

  • Pneumonia
  • Recurrent UTI; other infections
  • Sepsis
  • 10% weight loss
  • Progressive stage 3-4 pressure ulcers
  • Falls/changes in ambulatory status
  • Difficulty eating/dysphagia
  • Dehydration
  • Delirium
  • Difficulty speaking/aphasia
  • Albumin <2.5
 
 

Cancer

Consider hospice services if patient is no longer pursuing chemotherapy and/or immunotherapy. Patients will be considered in the terminal stage (life expectancy of six months or less) of their disease, if they meet the following criteria:

  • Disease with distant metastases at presentation OR
  • Progression from an earlier stage of the disease to metastatic disease with either:

    • Continued decline despite therapy.
    • Patient declines further disease-directed therapy.

NOTE: Certain cancers with poor prognoses (e.g. small cell lung cancer, brain cancer, and pancreatic cancer) may be hospice eligible without fulfilling the other criteria in this section.

 
 

Cardiac/Heart Disease

Consider hospice services if the patient meets all of the following criteria:

  • NYHA Class III or IV (fatigue, angina, or dyspnea at rest and/or with minimal exertion)
  • Multiple ER visits and hospitalizations
  • Not a surgical candidate
 
 

Liver Disease

Consider hospice services if the patient meets INR >1.5 and serum albumin <2.5 gm/dl with one of the following:

  • Recurrent ascites
  • Spontaneous Bacterial Peritonitis (SBP)
  • Hepatic encephalopathy
  • Recurrent variceal bleeding
  • Progressive malnutrition
  • HRS
 
 

Lung Disease

Consider hospice services if the patient meets the following:

  • Severe chronic Lung Disease
  • Disabling dyspnea at rest
  • Increasing visits to the emergency department or Hospitalizations for pulmonary infections and/or respiratory failure 
  • Oxygen Dependent
 
 

Stroke

Regardless of the specific diagnosis, patients with neurological diseases are eligible for hospice services when they experience a continuous decline in functional or clinical status over time, leading to a poor prognosis with a life expectancy of six months or less if they meet the following criteria:

  • Karnofsky Performance Status (KPS) or Palliative Performance Scale (PPS)
    of 40% or less
  • Inability to maintain hydration and caloric intake with one of the following:

    • Weight loss > 10% in the last six months or > 7.5% in the last three months
    • Serum albumin < 2.5 gm/dl
    • Current history of pulmonary aspiration
    • Not responsive to speech-language pathology intervention
    • Sequential calorie counts documenting inadequate caloric/fluid intake
    • Dysphagia severe enough to prevent the patient from receiving food and fluids necessary to sustain life in a patient who declines or does not receive artificial nutrition and hydration
 
 

Coma (Any Etiology)

Regardless of the specific diagnosis, patients with neurological diseases are eligible for hospice services when they experience a continuous decline in functional or clinical status over time, leading to a poor prognosis with a life expectancy of six months or less if they meet the following criteria:

Comatose patients with any 3 of the following on day three of coma:

  • Abnormal brain stem response
  • Absent verbal response
  • Absent withdrawal response to pain
  • Serum creatinine > 1.5 mg/dl
 
 

Sepsis

Hospice-eligible but not previously identified prognosis worsens with the following complications:

  • Vasopressors
  • Mechanical ventilation
  • Hyperlactemia
  • Acute kidney injury
  • Hepatic injury
  • Thrombocytopenia

 
 

End-Stage Renal Disease

Consider hospice services if the patient is no longer pursuing dialysis treatment:

  • Lab values: serum cr > 8.0 (6.0 for diabetic pt.)
  • Creatinine clearance < 10 cc/min (15 for diabetic pt.
  • Intractable hyperkalemia with k> 7.0
  • Oliguria with urine output < 400 cc/day. Or anuria
  • Comorbid conditions:
  • Heart Failure, Liver Disease, HRS, Uremia, Diabetes
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Still, have questions about whether a patient is eligible for hospice care? Contact HOPE Healthcare and Hospice for more information.

 

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