A patient will be considered to have a life expectancy of 6 months or less if they meet the non-disease-specific "Decline in clinical status" guidelines described in Part I. Alternatively, the baseline non-disease-specific guidelines described in Part II plus the applicable disease-specific guidelines (listed in a separate table) will establish the necessary expectancy. A patient will be considered to have a life expectancy of 6 months or less if there is documented evidence of decline in clinical status that is not considered to be reversible based on the guidelines below. |
I. Decline in clinical status guidelines |
A. Progression of disease as documented by worsening clinical status, symptoms, signs, and laboratory results |
Clinical status: |
a. Recurrent or intractable serious infections, such as pneumonia, sepsis, or pyelonephritis |
b. Progressive inanition as documented by: |
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Symptoms: |
a. Dyspnea with increasing respiratory rate |
b. Cough, intractable |
c. Nausea/vomiting poorly responsive to treatment |
d. Diarrhea, intractable |
e. Pain requiring increasing doses of major analgesics more than briefly |
Signs: |
a. Decline in systolic blood pressure to below 90 or progressive postural hypotension |
b. Ascites |
c. Venous, arterial, or lymphatic obstruction due to local progression or metastatic disease |
d. Edema |
e. Pleural/pericardial effusion |
f. Weakness |
g. Change in level of consciousness |
Laboratory (when available; lab testing is not required to establish hospice eligibility): |
a. Increasing pCO2 or decreasing pO2 or decreasing SaO2 |
b. Increasing calcium, creatinine, or liver function studies |
c. Increasing tumor markers (eg, CEA, PSA) |
d. Progressively decreasing or increasing serum sodium or increasing serum potassium |
B. Decline in KPS or PPS due to progression of disease |
C. Progressive decline in FAST for dementia (from 7A on the FAST) |
D. Progression to dependence on assistance with additional activities of daily living (refer to Part II, below) |
E. Progressive stage 3 to 4 pressure ulcers in spite of optimal care |
F. History of increasing emergency department visits, hospitalizations, or clinician visits related to the hospice primary diagnosis prior to election of the hospice benefit |
II. Non-disease-specific baseline guidelines (both A and B should be met) |
A. Physiologic impairment of functional status as demonstrated by KPS or PPS <70%. Note that 2 of the disease-specific guidelines (HIV and stroke/coma) establish a lower qualifying KPS or PPS. |
B. Dependence on assistance for 2 or more activities of daily living: |
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Comorbidities |
Although not the primary hospice diagnosis, the presence of comorbid disease that is likely to contribute to a life expectancy of 6 months or less should be considered for hospice eligibility. Comorbid diseases may include: |
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A patient will be considered to have a life expectancy of 6 months and be eligible for hospice services if they meet criteria for BOTH the above non-disease-specific baseline guidelines AND disease-specific guidelines (shown on a separate table). |
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