Healthcare Professionals

Guidelines for non-cancer diagnoses

These guidelines are not meant to be inclusive. They are examples of criteria requirements set forth by the National Hospice Organization. A consultation would be necessary to make a definitive determination regarding hospice appropriateness.

End-stage cardiovascular disease
  • Recurrent, persistent symptoms of CHF despite optimal/maximal treatments, including optimal therapy with diuretics and ACE inhibitors.
  • Recent episode of cardiac arrest, syncope, respiratory arrest
  • May or may not be oxygen dependent
  • Multiple hospitalizations related to a severe cardiac condition
  • Inability to perform physical activity of any kind without discomfort, pain, or shortness of breath
  • CVA of cardiac origin, such as an embolism
  • Ejection Fraction of ≤ 20%
  • Unstable weight
  • Uncontrolled edema
End-stage pulmonary Disease
  • Dyspnea at rest
  • Functional activity is limited so much that patient experiences a “bed-to-chair” existence, disabling dyspnea
  • Signs of right-sided heart failure
  • Multiple ER visits/hospitalizations for pulmonary infections or failure
  • Weight loss greater than 10% of body weight in last 3-6 months
  • Hypoxemia at rest (02 Sat < 88% on room air)
  • Frequent steroid and/or antibiotic use
  • Resting pulse rate > 100 beats/min
  • Progressive cough and fatigue
  • Previous requirement of a ventilator secondary to respiratory failure/infection
End-stage renal disease
  • Candidate for dialysis, but refuses
  • Stops dialysis to choose palliative care
  • Creatinine clearance < 10ml/min (< 15ml/min if diabetic)
  • Serum creatinine > 8.0mg/dl (> 6.0mg/dl if diabetic)
  • Hepatorenal Syndrome
  • Uremia
  • Oliguria (UO < 400ml/24 hrs)
  • Intractable hyperkalemia (> 7.0) not responsive to treatment
End-stage liver disease
  • Prothrombin time > 5 seconds over control or INR > 1.5 and and serum albumin < 2.5 mg/dl, with at least one of the following:
    • Recurrent bleeding or esophageal varices
    • Ascites, refractory to treatment or patient non-compliant
    • Hepatorenal syndrome (as evidenced by elevated BUN and Creatinine)
    • Hepatic encephalopathy and/or coma (very late stage)
End-stage HIV disease
  • Decisions to forego antiretroviral, chemotherapeutic, and prophylactic drug therapy related specifically to HIV disease
  • CD4+ count below 25 cells/mcl
  • Persistent HIV RNA (Viral load) of > 100,000 copies/ml
  • Opportunistic diseases such as CNS lymphoma, progressive multifocal leaukoencephalopathy, cryptosporidiosis, wasting, MAC bactermia, visceral Kaposi’s sarcoma, renal failure, AIDS dementia complex or toxoplasmosis.
End-stage ALS (Amyotrophic Lateral Sclerosis)
  • Rapid progression of ALS in last six months, as evidenced by: progression from ambulation or wheelchair to being bed bound, from normal to pureed diet, from independent or partial-assist to total assistance with ADL’s, no longer speaks intelligibly.
  • Must exhibit one of the following: Impaired breathing ability as evidenced by respiratory infections or failure, nutritional impairment responsible for >10% loss of body weight in <6 months, or life-threatening complications like pneumonia, urosepsis, etc.
End-stage dementia; Alzheimer’s/Multi-Infarct
  • Exhibits all the following: Unable to ambulate, dress, or bathe without assistance; unable to converse meaningfully with others, incontinent of urine and stool.
  • Cannot sit upright in geri-chair or wheelchair without support
  • Difficulty swallowing food, liquids or medications
  • No longer smiling or interacting with caregivers
  • History of frequent UTI’s, urosepsis, pneumonia, septicemia
  • Multiple decubiti
  • Weight Loss
End-stage Stroke, CVA
  • Dysphagia may or may not be a candidate for artificial nutrition/hydration
  • A Palliative Performance Scale ≤ 40
  • Greater than 10% weight loss despite enteral feedings
  • Comorbid conditions such as aspiration pneumonia, multiple decubiti, septicemia, urosepis, or frequent UTIs
  • Unable to communicate meaningfully