When your patient’s illness has advanced to the point that curative treatments are no longer effective, hospice care gives you, your patient, and the family another option. There is no one moment when a patient’s condition suddenly makes him or her hospice appropriate; however, the following signs and symptoms are a good indicator that it is time to consider hospice:

  • ALS

    • Rapid progression in last year
    • Impaired breathing at rest
    • Insufficient nutrition / hydration
    • Recurrent aspiration pneumonia
    • Upper urinary tract infection
    • Sepsis
    • Recurrent fever
    • Decubitus ulcers

  • Dementia

    • Inability to walk
    • Incontinence
    • Fewer than six intelligible words
    • Albumin < 2.5 or decreased PO intake
    • Frequent ER visits

  • Diseases with Short Prognosis

    • Esophageal cancer
    • Pancreatic cancer
    • Glioblastoma
    • Liver cancer
    • Gall bladder cancer
    • Any cancer with generalized metastases; metastasis to brain, liver, bone; or unresectable

  • Heart Disease

    • CHF symptoms at rest
    • EF of < 20%
    • New dysrhythmia
    • Cardiac arrest, syncope, or CVA
    • Frequent ER visits for symptoms

  • Liver Disease

    • PT > 5 seconds
    • Albumin < 2.5
    • Refractory ascites
    • Spontaneous bacterial peritonitis
    • Jaundice
    • Malnutrition and muscle wasting

  • Lung Cancer

    • Advanced disease stage
    • Albumin < 2.5
    • Calcium ≥ 12.0
    • Metastasis to brain, bone
    • Decreasing functional status

  • Multi-system Failure

    • Frequent ER visits
    • Albumin < 2.5
    • Unintentional weight loss
    • Decubitus ulcers
    • Homebound / bed-confined

  • Pulmonary Disease

    • Dyspnea at rest
    • Signs or symptoms of right heart failure
    • O2 sat on O2 of < 88%
    • P CO2 > 50
    • Unintentional weight loss

  • Renal Disease

    • Not a candidate for dialysis
    • Creatinine clearance of < 15 ml/minute
    • Serum creatinine > 6.0

  • Stroke – Acute

    • Secondary coma > 3 days
    • Dysphagia

  • Stroke – Chronic

    • Post-stroke dementia
    • Poor functional status
    • Unintentional weight loss
    • Serum albumin < 2.5
Source: The National Hospice and Palliative Care Organization

Looking to Refer?

Admission to hospice requires a clinical judgment that a patient’s prognosis is less than six months. However, patients can receive hospice services for longer than six months and do benefit from early referral. Our medical director and staff are available to answer your questions regarding the appropriateness of hospice, so please do not hesitate to contact us.