Admission Criteria

Hospice Admission Guidelines

Hospice care may be appropriate when a person is experiencing a life-limiting illness, continued decline, increasing symptoms, or a growing need for assistance and support.

The presence of two or more indicators within any category may suggest that a hospice evaluation would be beneficial. A referral does not obligate a patient or family to enroll in hospice. It simply allows our clinical team to review the individual’s condition, answer questions, and determine whether hospice services may be appropriate.

Please call the Berkley Hospice intake team at 720.722.9020 to discuss your needs or the needs of someone you care about.

General Indicators

A life-limiting illness or condition
A preference for comfort and symptom management rather than curative treatment
Continued progression of one or more diseases
Unintentional weight loss or serum albumin below 2.5 g/dL
Increasing weakness, fatigue, pain, shortness of breath, confusion, or other signs of decline
Karnofsky Performance Status or Palliative Performance Scale score of approximately 50% or lower
Dependence in two or more activities of daily living, such as bathing, dressing, eating, transferring, toileting, or walking
Frequent hospitalizations, emergency room visits, or physician appointments
Progressive or nonhealing Stage III or Stage IV pressure injuries

Cancer

Hospice evaluation may be appropriate when there is evidence of widespread, aggressive, recurrent, or progressive cancer, including:

Increasing symptoms or worsening laboratory findings
Evidence of metastatic disease
Declining functional status
Palliative Performance Scale score below 70%
Continued decline despite surgery, radiation, chemotherapy, immunotherapy, or other treatment
A decision to discontinue or decline additional disease-directed treatment
Recurrent disease following treatment
Hypercalcemia of 12 mg/dL or greater
Cachexia or unintentional weight loss of 5% or more during the preceding three months
Symptoms of advanced disease, such as nausea, anemia, malignant ascites, pleural effusion, pain, weakness, or reduced oral intake

Pulmonary Disease

Hospice evaluation may be appropriate for severe or end-stage pulmonary disease with indicators such as:

Disabling shortness of breath at rest that responds poorly to bronchodilators
FEV1 after bronchodilator below 30% of predicted
Continued progression of end-stage pulmonary disease
Recurrent pneumonia or other pulmonary infections
Hypoxemia at rest on room air, with a pO2 below 55 mmHg or oxygen saturation below 88%
Right-sided heart failure related to pulmonary disease
Unintentional progressive weight loss exceeding 10%
Persistent tachycardia at rest
Increasing oxygen needs or reduced tolerance for activity

Stroke and Coma

Stroke

Indicators may include:

Karnofsky Performance Status below 40%
Inability to maintain adequate nutrition or hydration
Unintentional weight loss exceeding 10%
Serum albumin below 2.5 g/dL
Recurrent aspiration
Severe difficulty swallowing
Significant functional or neurological decline

Coma

A hospice evaluation may be appropriate when three or more of the following are present on the third day of coma:

Abnormal brain-stem response
Absence of verbal response
Absence of withdrawal response to pain
Serum creatinine above 1.5 mg/dL

Cardiac Disease

Hospice evaluation may be appropriate for advanced cardiac disease when the patient remains symptomatic despite optimal medical treatment.

Indicators may include:

Recurrent congestive heart failure exacerbations
New York Heart Association Class IV symptoms
Ejection fraction below 20%
Shortness of breath or chest discomfort at rest
Significant limitation in activity
Arrhythmias that are resistant to treatment
History of cardiac arrest or resuscitation
History of unexplained fainting or syncope
Cardiogenic embolic disease, including stroke
Frequent hospitalizations or emergency care for cardiac symptoms

Acute Renal Failure

Hospice evaluation may be appropriate when the patient is not pursuing dialysis or kidney transplantation and has indicators such as:

Serum creatinine above 8 mg/dL, or above 6 mg/dL for a patient with diabetes
Glomerular filtration rate below 10 mL/min
Creatinine clearance below 10 mL/min, or below 15 mL/min for a patient with diabetes
Significant coexisting illnesses or complications
Progressive weakness, confusion, nausea, poor intake, or fluid overload

Chronic Renal Failure

Hospice evaluation may be appropriate when the patient is not pursuing dialysis or kidney transplantation and has indicators such as:

Creatinine clearance below 10 mL/min, or below 15 mL/min for a patient with diabetes
Serum creatinine above 8 mg/dL, or above 6 mg/dL for a patient with diabetes
Glomerular filtration rate below 10 mL/min
Uremia
Oliguria or markedly reduced urine output
Confusion
Persistent nausea or vomiting
Severe itching
Restlessness
Hyperkalemia above 7.0 that does not respond to treatment
Intractable fluid overload that does not respond to treatment

Liver Disease

Hospice evaluation may be appropriate for end-stage liver disease with indicators such as:

Prothrombin time prolonged by more than five seconds above control
Serum albumin below 2.5 g/dL
Ascites that does not respond to treatment
Spontaneous bacterial peritonitis
Hepatorenal syndrome
Hepatic encephalopathy that does not respond to treatment
Progressive malnutrition
Continued alcohol use contributing to disease progression
Hepatocellular carcinoma
Recurrent hospitalizations or complications related to liver failure

Dementia

Hospice evaluation may be appropriate for advanced dementia, including a Functional Assessment Staging score of approximately 7, with indicators such as:

Inability to walk without assistance
Dependence with dressing or bathing
Urinary and fecal incontinence
Little or no consistently meaningful verbal communication
Aspiration pneumonia
Recurrent urinary tract infections
Septicemia
Recurrent fevers
Stage III or Stage IV pressure injuries
Unintentional weight loss exceeding 10% during the previous six months
Difficulty swallowing or reduced food and fluid intake
Increasing sleep, weakness, or inability to recognize familiar people

Amyotrophic Lateral Sclerosis

Hospice evaluation may be appropriate for ALS when there is significant respiratory, nutritional, or functional decline.

Indicators may include:

Critically impaired respiratory function
Shortness of breath at rest
Use of accessory muscles for breathing
Respiratory rate above 20 breaths per minute
Reduced speech volume or difficulty speaking
Unexplained headaches, anxiety, nausea, or symptoms associated with respiratory insufficiency
Severe nutritional impairment
Progressive weight loss of at least 5% of body weight
Continued decline with or without placement of a feeding tube
Increasing dependence with mobility and personal care

HIV/AIDS

Hospice evaluation may be appropriate for advanced HIV/AIDS with indicators such as:

CD4 count below 25 cells/mcL
Persistent viral load exceeding 100,000 copies/mL
Declining functional or performance status
Chronic, persistent diarrhea
Persistent serum albumin below 2.5 g/dL
Advanced AIDS-related dementia
Congestive heart failure
Advanced liver disease
Ongoing substance use that complicates treatment or care
Age over 50 in combination with advanced disease and other indicators of decline

When to Call Berkley Hospice

You do not need to wait for a crisis or hospitalization to ask about hospice. Earlier conversations can give patients and families more time to understand their options, manage symptoms, coordinate care, and receive meaningful support.

Call our intake team at 720.722.9020 for a confidential consultation or hospice eligibility evaluation.

These guidelines are provided for general informational purposes. Hospice eligibility is determined individually based on the patient’s diagnosis, prognosis, clinical condition, goals of care, applicable Medicare requirements, and certification by the appropriate physicians.