© 2018- 2019 Berkley Hospice

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

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