When to Consider Hospice

If any of these sound familiar, it may be appropriate to consider Hospice care:

Struggle to Manage Chronic Conditions

• Loss of functional abilities

• Reduced activity tolerance

• Weight loss, difficulty swallowing, refusing food, decrease appetite

• Dehydration and changes in renal function

• Increasing frailty

• Increase sleep

• Withdrawal/depression

• Diminished cognitive abilities

• Bowel and bladder incontinence

• Loss of speaking ability

 When is an ALS patient eligible for hospice care?

Patients are considered to be hospice-eligible for amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) if they meet the following guidelines:

• BOTH rapid progression of ALS and decreased ability to breath on one’s own or

• BOTH rapid progression of ALS and critical nutritional impairment with a decision not to

  receive artificial feeding or

• BOTH rapid progression of ALS and life-threatening complications such as:

  • Recurrent aspiration pneumonia

  • Pressure sores/impaired skin integrity, multiple, stage 3-4, particularly if infected

  • Upper urinary tract infection

  • Sepsis

  • Fever that continues after antibiotics

Patients with neurological diseases may be eligible for hospice when they experience the following signs or symptoms: STROKE, PARKINSON’S, MULTIPLE SCLEROSIS

• Severely compromised breathing, marked by inability to clear respiratory secretions, persistent cough, or recurring aspiration pneumonia

• Increased shortness of breath, even at rest or on oxygen

• Inability to swallow liquids or soft food without choking or coughing; progression to a mainly pureed diet

• Spends most of the time in the same room, chair or bed

• Barely intelligible speech

• Continued weight loss

• Inability to manage most activities of daily living

Oncology

Typically, these patients:

• Are unable to carry on normal activity or do normal work

• Are unable to move or ambulate; spend more than 50% of their time in a bed, chair or a single room

• Exhibit evidence of significant disease

• Are able to provide only limited self-care

• Have reduced nutritional intake

Other indicators and symptoms:

• Patient refusing dialysis or stopping dialysis

• 25%–30% of patients on dialysis who are declining with other comorbid disease, such as cancers, end-stage heart disease, end-stage lung disease

• Weight loss

• Functional decline

• Cognitive decline

• Social withdrawal

• Uncontrolled pain

• Frequent nausea

 End-Stage Renal Disease

Common indicators of end-stage renal disease:

• Confusion, decreased level of consciousness, uncontrolled nausea and vomiting, generalized itching of the skin, restlessness, "restless legs"

• Decreased urine output: urine output <400 cc/24 hrs

• uncontrolled hyperkalemia: persistent serum potassium >7.0

• Uremic pericarditis

• Hepatorenal syndrome

• uncontrolled fluid overload

Other indicators and symptoms:

• Patient refusing dialysis or stopping dialysis

• 25%–30% of patients on dialysis who are declining with other comorbid disease, such as cancers, end-stage heart disease, end-stage lung disease

• Weight loss

• Functional decline

• Cognitive decline

• Social withdrawal

• Uncontrolled pain

• Frequent nausea

• Increasing weakness

• Low blood pressure caused by position changes

• Dehydration

• Decreasing muscle mass

• Impaired immune function

• Increase in infections

• Decrease in sympathetic response to stressors

“Almost six million Americans have heart failure and more than 870,000 people are diagnosed with heart failure each year.” Cleveland Clinic

“Heart failure is the leading cause of hospitalization in people older than 65.” Cleveland Clinic

 Heart Failure Patients

Hospice Benefit Qualifiers

• Angina (chest pain)

• Fatigue

• Diminished exercise capacity

• Shortness of breath

• Less ability to function normally

• Symptomatic at rest

• Edema

• Mostly bed-bound

• Heart medication no longer effective

• Not a candidate for further surgical or medical intervention

  If any of the above sound familiar, it may be appropriate to consider Hospice care.

Dementia Patients

 Hospice Benefit Qualifiers

• Dependence on others for assistance with activities of daily living

• Inability to walk without assistance

• Speaking only a few words and phrases

• Continuous anxiety and stress

• Falls

• Multiple hospitalizations and/or ER trips

• Infections

• Eating problems

• Incontinence

If any of the above sound familiar, it may be appropriate to consider Hospice care.

Dementia is a leading cause of death in the United States, but is underrecognized as a terminal illness - NEJM 2009