The following parameters may be used to help determine whether a patient is appropriate for hospice care. The patient should meet all of the following criteria:
1. The patient's condition is life limiting, and the patient and/or family have been informed of this determination. A "life-limiting condition" may be due to a specific diagnosis, a combination of diseases, or there may be no specific diagnosis defined.
2. The patient and/or family have elected treatment goals directed toward relief of symptoms, rather than cure of the underlying disease.
3. The patient has either of the following:
. Documented clinical progression of disease, which may include:
. Progression of the primary disease process as listed in disease-specific criteria, as documented by serial physician assessment, laboratory, radiologic, or other studies.
. Multiple emergency department visits or inpatient hospitalizations during the prior six months.
. For homebound patients receiving home health services, nursing assessment may be documented.
. For patients who do not qualify under A1, 2 or 3, a recent decline in functional status may be documented. Functional decline should be recent, to distinguish patients who are terminal from those with reduced baseline functional status due to chronic illness. Clinical judgment is required for patients with a terminal condition and impaired status due to a different non-terminal disease, e.g., a patient chronically paraplegic from spinal cord injury who has been recently diagnosed with cancer.
. Diminished functional status may be documented by either (*) Karnofsky Performance Status of less than or equal to 50% or (**) dependence in at least three of six Activities of Daily Living: (i) bathing, (ii) dressing, (iii) feeding, (iv) transfers, (v) continence of urine and stool, (vi) ability to ambulate independently to bathroom.
. Documented recent impaired nutritional status related to the terminal process.
. Unintentional, progressive weight loss of greater than 10% over the prior six months.
. Serum albumin less than 2.5 gm/dl may be a helpful prognostic indicator, but should not be used in isolation from other factors in A1-3 above.
Adapted from U.S. Department of Health and Human Services. Assistant Secretary for Planning and Evaluation. Important questions for hospice in the next century. Internet. Accessed on April 29, 2010.