Diagnosis-based guidelines for Medicare eligibility
HOSPICE REFERENCE GUIDELINES
NOTE:In situations of co-morbidities and/or rapid decline, patients may be hospice-appropriate even without meeting the diagnosis criteria listed below. The presence of two or more conditions within a given diagnosis warrants a hospice consultation.
General Guidelines – All Diagnoses
General Guidelines – All Diagnoses
Life-limiting condition(s) /progression of disease(s)
Karnofsky score ≤ 50%
Dependence in 3 of 6 ADLs
Weight loss > 10% over past 6 months
Serum albumin ≤ 2.5
BMI < 22kg/m2
End-stage Heart Disease
End-stage Heart Disease
Functional Class IV NYHA Assessment
Symptomatic despite optimal diuretic and vasodilator therapy
Arrhythmia resistant to treatment
Ejection fraction ≤ 20%
History of cardiac arrest
Cardiogenic embolic disease (e.g. CVA)
End-stage Lung Disease
End-stage Lung Disease
Disabling dyspnea at rest or unresponsive to bronchodilators
Progression of pulmonary disease resulting in recurring infections or respiratory failure
Hypoxemia at rest on room air. 02 sats. < 88% or P02. < 55 mmHg FEV 1 < 30% after bronchodilator
Right heart failure due to lung disease
Resting tachycardia
Cancer
Cancer
NOTE:Bothcriteria 1 & 2 as well as either 3 or 4 must be present for hospice eligibility. However, certain cancer patients with poor prognoses may be hospice eligible without fulfilling any of these criteria.
Palliative Performance Scale 70%
Dependence in 2 or more ADLs
Pathology report indicates evidence of malignancy or metastases
Progression from earlier stage of disease to metastatic disease with either of the following:
Signs of uremia (confusion, nausea, pruritus, restlessness)
Urine output < 400 cc/24 hrs.
Hyperkalemia > 7.0
End-stage Liver Disease
End-stage Liver Disease
Not a candidate for liver transplant
PTT > 5 seconds over control
Ascites despite maximum diuretics
Serum albumin < 2.5
Peritonitis spontaneous bacterial
Cirrhosis or ascites
Somnolence or coma
Recurrent variceal bleeding
End-stage Neurologic Disease/ALS
End-stage Neurologic Disease/ALS
Unable to walk; needs assistance in all ADLs
Barely intelligible or unintelligible speech
Significant dyspnea on 02
Nutritional status declining
Medical complications, e.g.: aspiration pneumonia, UTI, decubitus ulcers, recurrent fever
End-stage Dementia/Alzheimer’s
End-stage Dementia/Alzheimer’s
FAST score of 7 or below
Speech limited to 6 words or less
Unable to sit up, hold head up or smile
Incontinent
Requires assistance to dress. bathe and ambulate
Medical complications, e.g.: recurrent aspiration, pneumonia, UTI, sepsis, decubitus ulcers
CVA and Coma
CVA and Coma
Nutritional status declining due to dysphagia; not a candidate for feeding tube
Poor functional status PPS score < 40%
Medical complications e.g.: aspiration pneumonia, UTI, decubitus ulcers
Persistent vegetative state/comatose
HIV
HIV
CD4+ count ≤ 25 cells/rnc/L
Viral load < 100,000 copies/ml. Patient has elected to forego antiretroviral meds
Any of the following life-threatening complications:
CNS lymphoma
Wasting loss of 33% lean body mass
Renal failure
Persistent diarrhea & serum albumin < 2.5
Congestive heart failure
Our Management Team
BOARD OF DIRECTORS
Cosmetic Surgeon
Stephanie Wosniack
Mauris fermentum tristique laoreet. Etiam sagittis erat quis cursus bibendum. Vestibulum elementum urna interdum velit dapibus, non faucibus sapien auctor. Nunc ullamcorper ultricies dignissim.
Pediatrician
Hellen Lowe
Aliquam egestas, ipsum sed semper placerat, mauris ligula tempus ipsum, quis lacinia dui sem vitae purus. Quisque felis felis, facilisis eu maximus non, luctus ac dui.
Dental surgeon
Emily Washington
Duis ac ultrices felis, quis volutpat ipsum. Aenean augue metus, suscipit non risus quis, malesuada suscipit urna. Nulla facilisi. Donec hendrerit rutrum nibh, id egestas magna sodales a.
We are always looking for good and talented people