Non-disease Specific Baseline Guidelines

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Part I

Decline in clinical status listed in order of likelihood to predict poor survival.

Progression of disease as documented by worsening clinical status, symptoms, signs and laboratory results.

Clinical Status (no specific number of items has to be met for eligibility)

1. Recurrent or intractable infections such as pneumonia, sepsis or upper urinary tract

2. Progression inanition as documented by (wt change):

3. Dysphagia leading to recurrent aspiration/inadequate oral intake documented by decreasing food portion consumption.

Symptoms

1. Dyspnea with increasing respiratory rate
2. Cough, intractable
3. Nausea/vomiting poorly responsive to treatment
4. Diarrhea, intractable
5. Pain requiring increasing doses of major analgesics more than briefly

Signs

1. Decline in systolic blood pressure to below 90 or progressive postural hypotension
2. Ascites
3. Venous, arterial or lymphatic obstruction due to local progression or mestastatic disease
4. Edema
5. Pleural/pericardial effusion
6. Weakness
7. Change in level of consciousness

Laboratory

(lab testing is NOT required to establish hospice eligibility

1. Increasing pCO2 or decreasing pO2 or decreasing SaO2
2. Increasing calcium, creatinine or liver function studies
3. Increasing tumor markers (e.g. CEA, PSA)
4. Progressively decreasing or increasing serum sodium or increasing serum potassium

Change in arterial blood gases/pulse oximetry

Change in metabolic studies, electrolyte balance

Decline in Karnofsky Performance (KPS) or Palliative Performance (PPS) less than 70% due to progression of disease

*See Appendix 4: Karnofsky Scale

*See Appendix 2: Palliative Performance Sacle

Increasing emergency room visits, hospitalizations, or physician's visits related to the hospice primary diagnosis. RECERT: Increased/decreased usage of continuous/general inpatient

Progressive decline in Functional Assessment Staging (FAST) for DEMENTIA (≥7A on the FAST)

*See Appendix 3: Functional Assessment Staging (FAST)

Progression to dependence on assistance with more Activities of Daily Living (ADL's)

Change in dependence

*See Appendix 4: Functional Assessment Staging (FAST)

Progressive Stage 3-4 pressure ulcers in spite of optimal care

RECERT: Change in skin integrity

Part II Non-disease specific baseline guidelines

Both 1 & 2 should be met:

1. Physiologic impairment of functional status as demonstrated by KPS or PPS less than 70% (NOTE: HIV disease and Stroke and Coma establish lower qualifying KPS or PPS)

2. Dependance on assistance for two or more ADLs

*See Appendix 4: Activities of Daily Living (ADL) Scale

Part III Comorbidities

(presence contributes to life expectancy 6 months or less)

  • Chronic obstructive pulmonary disease
  • Congestive heart failure
  • Ischemic heart disease
  • Diabetes mellitus
  • Acquired immune deficiency syndrome
  • Renal failure
  • Liver disease
  • Neoplasia
  • Neurologic disease (CVA, ALS, MS)
  • Dementia

RECERT: Identification/development of new/change in comorbidities.

*The condition of some pts receiving hospice care may stabilize or improve during or do to that care.

*If a patient improves or stabilizes sufficiently over time while in hospice such that he/she no longer has a prognosis of 6 months or less from the most recent recert evaluation, that pt should be considered for discharge from the Medicare Hospice Benefit. Such pt can be re-enrolled such the time life expectancy is again 6 months or less.

On the other hand, pts in the terminal stage of their illness who originally qualify for the Medicare Hospice Benefit but stabilize or improve while receiving hospice care, yet have a reasonable expectation of continued decline for a life expectancy of less than 6 months, remain eligible for hospice care.