HOSPICE CRITERIA BY DISEASE

ALS

• Rapidly progressing disease
• Dyspnea at restNeeds O2 at rest
• Poor oral intake of food or fluid
• Weight lossRecurrent infection (such as pneumonia, pyelonephritis or sepsis) or recurrent fever after antibiotics
• Decubitus ulcers
• Vital capacity < 30 % of normalDesire not to be intubated
• Desire not to be hospitalized
• Other comorbid disease that may shorten survival
• Difficulty with feeding, ambulation, continence, transfer, bathing or dressing

CANCER

• Weight loss
• Metastatic disease
• Progression from an earlier stage despite therapy
• Desire to no longer pursue curative treatment (Palliative radiation may be continued)
• Desire not to be hospitalized if the illness worsens
• Other comorbid disease that may shorten survival
• Difficulty with feeding, ambulation, continence, transfer, bathing or dressing

DEMENTIA

• Difficulty speaking intelligibly
• Difficulty sitting up
• Difficulty smiling or holding up the head
• Decubitus ulcers
• Infection during the past year (such as pneumonia, pyelonephritis or sepsis) or recurrent fever after antibiotics
• Weight loss
• Poor oral intake of food or fluid
• Desire not to be hospitalized if the illness worsens
• Other comorbid disease that may shorten survival
• Difficulty with feeding, ambulation, continence, transfer, bathing or dressing

HEART DISEASE

• Symptomatic CHF despite diuretics and vasodilators
• Angina at rest despite medical management
• Angina at rest and not a surgical candidate or refuses surgery
• New York Heart Association Class IV diseaseEF < 20%
• Refractory symptomatic SVT or ventricular arrhythmia
• History of cardiac arrestUnexplained syncope
• Cardiogenic brain embolism
• Desire not to be hospitalized if the illness worsens
• Other comorbid disease that may shorten survival
• Difficulty with feeding, ambulation, continence, transfer, bathing or dressing

HIV

• CD4 count < 25 cells/mcL or viral load > 100,000 copies/mL
• Weight loss
• Debility
• Chronic diarrhea
• Serum albumin < 2.5 gm/dL
• Antiretroviral therapy no longer effective or too toxic
• Cancer such as CNS or systemic lymphoma, visceral Kaposi's sarcoma
• AIDS dementia or progressive multifocal leukoencephalopathy
• Infection such as Mycobacterium avium complex bacteremia, toxoplasmosis, Cryptosporidium
• Ongoing substance abuse
• Other comorbid disease such as CHF, liver disease or renal failure that may shorten survival
• Desire not to be hospitalized if the illness worsens
• Difficulty with feeding, ambulation, continence, transfer, bathing or dressing 

KIDNEY DISEASE

• Desire to stop or forego dialysis
• Creatinine clearance < 15-20 cc/min or serum creatinine > 6 mg/dL
• Cachexia or serum albumin < 3.5 gm/dL
• Uremia
• Hyperkalemia
• Uremic pericarditis
• Fluid overload or oliguria
• Hepatorenal syndrome
• GI bleeding, DIC or platelets < 25,000
• Infection such as HIV or sepsis
• Other comorbid disease such as heart, liver or chronic lung disease that may shorten survival
• Desire not to be hospitalized if the illness worsensDifficulty with feeding, ambulation, continence, transfer, bathing or dressing

LIVER DISEASE

• Protime > 5 seconds over control or INR > 1.5
• Serum albumin < 2.5 gm/dL
• Ascites
• Spontaneous bacterial peritonitis
• Hepatorenal syndrome
• Hepatic encephalopathy
• Recurrent variceal bleeding
• Malnutrition or muscle wasting
• Ongoing alcoholism
• Hepatitis B antigen positive
• Refractory hepatitis C
• Hepatocellular carcinoma
• Plan for liver transplantation but no donor organ available
• Other comorbid disease that may shorten survival
• Desire not to be hospitalized if the illness worsens
• Difficulty with feeding, ambulation, continence, transfer, bathing or dressing

LUNG DISEASE

• Dyspnea at rest despite bronchodilators
• Declining functional status
• FEV1 < 30% predicted
• Falling FEV1 (by > 40 mL/year)
• O2 saturation < 88% or pO2 < 55 mmHg on room airp
• CO2 > 50 mmHgCor pulmonale (right heart failure)
• Weight loss
• Resting tachycardia
• Desire not to be hospitalized if the illness worsens
• Other comorbid disease that may shorten survival
• Difficulty with feeding, ambulation, continence, transfer, bathing or dressing

STROKE/COMA

• Weight loss
• Serum albumin < 2.5 gm/dL
• Dysphagia or aspiration
• Poor intake of food or fluid
• Coma for 3 days with absent verbal, withdrawal or brainstem responses, or serum creatinine > 1.5 gm/dL
• Infection (such as pneumonia, pyelonephritis, or sepsis) or recurrent fever after antibiotics
• Decubitus ulcers
• Large-volume hemorrhage, ventricular extensionof hemorrhage, midline shift, or obstructive hydrocephalus by CTLarge infarcts
• Basilar or bilateral vertebral artery occlusion
• Other comorbid disease that may shorten survival
• Desire not to be hospitalized if the illness worsens
• Difficulty with feeding, ambulation, continence, transfer, bathing or dressing