ALS
  • Significant decline in function
  • Rapid progression of ALS
  • Affected respiratory status
  • Secondary conditions such as weight loss or recurrent infections
Liver Disease
  • PT>5 over control or INR >1.5
  • Serum albumin <2.5
  • Secondary conditions such as jaundice and/or ascites; peritonitis; hepatorenal syndrome; hepatic encephalopathy; or recurrent variceal bleeding
Renal Disease
  • Patient is not seeking the initiation of dialysis
  • Creatinine clearance <10cc/min
  • Serum creatinine >8.0mg/dl
  • Not a candidate for transplant
Heart Disease
  • Patient is symptomatic despite maximum medical management with diuretics and vasodilators
  • Shortness of breath with minimal activity
  • Significant symptoms of recurrent CHF at rest
Neurological Disease
(Alzheimer's/Dementia)
  • Ability to pronounce/articulate words is limited to 1-5 words/day
  • Comorbid or secondary conditions
  • Weight loss during the last six months
Stroke
  • Unable to bathe/dress without assistance
  • Weight loss
  • Serum albumin <2.5gm/dl
  • Current history of pulmonary aspiration
  • Food and fluid intake is reduced
HIV/AIDS
  • CD4+ count <25 or viral load > 100,000
  • Not responding to treatment
  • Weight loss
  • Comorbid conditions
  • Decreased performance status
Pulmonary Disease
  • Disabling dyspnea at rest
  • Increased hospitalizations or ER visits
  • Unintentional weight loss
  • Progression of end-stage pulmonary disease
  • Hypoxemia on room air
  • Hypercapnia
If your patient does not meet these guidelines but is still thought to be appropriate for hospice (i.e. has comorbidities or a recent rapid decline), please call us for an assessment.