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Hospice Admission Guidelines

Two or more items in any category should generate a hospice referral. Please call our intake team at 303.758.2000 so we can discuss your or your loved ones needs

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General Guidelines
Life-limiting condition

• Patient/family focus on symptom relief rather than cure

• Progression of disease(s)

• Evidence of weight loss; serum albumin < 2.5g/dl

• Symptoms & signs that paint a picture of decline

• Karnofsky or Palliative Performance Scale score < 50%

• Dependence in at least 2 ADLs

• Need for frequent hospitalization, office or ER visits

• Progressive/unhealing stage III or IV pressure ulcers

Cancer
Clinical findings of malignancy with widespread, aggressive or progressive disease as evidenced by increasing symptoms, worsening lab values and/or evidence of metastatic disease

• Impaired performance on Palliative Performance Scale of <70%

• Refuses further curative therapy or continues to decline despite definitive therapy. Decline evidenced by:

  • Hypercalcemia > or = 12

  • Cachexia or weight loss of 5% in the preceding 3 months

  • Recurrent disease after surgery/radiation/chemotherapy

  • Refusal to pursue additional curative or prolonging cancer treatment

  • Signs and symptoms of adcanced diesease (nausea, anemia, malignant ascites or pleural effusion, etc.)

Pulmonary Disease

• Severe chronic lung disease

  • Disabling dyspnea at rest, poorly responsive to bronchodilators

  • FEV1 after bronchodilator < 30%

• Progression of end-stage pulmonary disease

  • Recurrent pulmonary infections

• Hypoxemia at rest, on room air: pO2 < 55mmHg - or O2 sat < 88%

• Right heart failure secondary to pulmonary disease

• Unintentional progressive weight loss >10%

• Persistent resting tachycardia

Stroke and Coma

• Karnofsky Performance < 40%

• Inability to maintain nutrition/hydration

  • Weight loss > 10%, serum albumin < 2.5 gm/dl, pulmonary

• aspiration, severe dysphagia

• Coma with any 3 of the following on day 3 of coma

  • Abnormal brain stem response

  • Absent verbal response

  • Absent withdrawal response to pain

  • Serum creatinine > 1.5 mg/dl

Cardiac Disease

• Symptomatic despite optimal treatment with diuretics and vasodilators

• Recurrent CHF

  • Ejection fraction < 20%

• New York Heart Association Class IV

• Supporting factors

  • Arrhythmias are resistant to treatment

  • History of cardiac arrest or resuscitation

  • History of unexplained syncope

  • Cardiogenic embolic disease (e.g., CVA)

Renal Disease – Acute Renal Failure

• Patient is not seeking dialysis or transplant

  • Creatinine > 8mg/dl (> 6mg/dl for diabetics)

• GFR < 10ml/min

  • Creatinine clearance <10cc/min (<15cc/min for diabetics)

• Co-morbid conditions

Renal Disease – Chronic Renal Failure

• Patient is not seeking dialysis or transplant

• Creatinine clearance <10cc/min (<15cc/min for diabetics)

  • Creatinine > 8mg/dl (> 6mg/dl for diabetics); GFR < 10ml/min

• Symptoms: uremia; oliguria; confusion; nausea; vomiting; pruritus; restlessness; hyperkalemia > 7.0, not responsive to treatment; intractable fluid overload, not responsive to treatment

Liver Disease

• PTT > 5 seconds over control

• Serum Albumin < 2.5gm/dl

• End-stage liver disease

  • Ascites refractory to treatment

  • Spontaneous bacterial peritonitis

  • Hepatorenal syndrome

  • Hepatic encephalopathy, refractory to treatment

• Supportive factors

  • Progressive malnutrition

  • Continued alcoholism

  • Hepatocellular carcinoma

Dementia

• Functional Assessment score = 7

  • Unable to ambulate without assist

  • Unable to dress or bathe without assist

  • Urinary and fecal incontinence, intermittent or constant

  • No consistently meaningful verbal communication

• Complications such as aspiration pneumonia, UTI, septicemia, recurrent fevers

• Decubitus ulcers stage 3 or 4

• Weight loss of >10% over last six months

ALS

• Critically impaired respiratory function

  • Dyspnea at rest

  • Use of accessory muscles

  • Respiratory rate > 20

  • Reduced speech / vocal volume

  • Unexplained headaches, anxiety or nausea

• Severe nutritional insufficiency

  • Progressive weight loss of at least 5% of body weight

• With or without gastrostomy tube insertion

HIV

• CD4 count < 25 cells/mcl or persistent viral load >100,000 copies/ml

• Decreased performance status

• Supporting factors

  • Chronic persistent diarrhea

  • Persistent serum albumin < 2.5

  • Concomitant substance abuse

  • Age > 50

  • Advanced AIDS dementia complex

  • CHF or advanced liver disease