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Hospice Eligibility Guidelines

The following are some of the most common diseases to that lead to the need for hospice services. Each situation should be determined by a physician for appropriate diagnosis and prognosis.

If you would like assistance in determining your eligibility or have questions about Nightingale’s services

ALS

When is an ALS patient eligible for hospice care?

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

Rapid progression of ALS AND critically impaired respiratory functions

Rapid progression of ALS AND critical nutritional impairment with a decision against placing a feeding tube

Rapid progression of ALS AND life-threatening complications such as:

  • Recurrent aspiration pneumonia

  • Multiple decubitus ulcers (Stages 3-4)

  • Frequent urinary tract infections

  • Sepsis

  • Recurrent fever after antibiotics

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Alzheimer’s and Dementia

Alzheimer’s and Dementia

When is a dementia patient ready for hospice?

Alzheimer’s disease and other progressive dementias are life-altering and eventually fatal conditions which have no cure.

Patients with Alzheimer’s disease or dementia are eligible for hospice care when they begin to show the following characteristics:

  • Unable to walk without assistance

  • Unable to dress without assistance

  • Unable to bathe without assistance

  • Incontinence of bowel and bladder

  • Unable to speak or communicate meaningfully

If your loved one is experiencing one or a combination of these concerns, please contact Nightingale Hospice to receive information as to how we can work with you.

Hospice Eligibility Guidelines

The following examples are guidelines for determining the disease applicable to a terminally ill prognosis. Each situation should be determined by a physician for appropriate diagnosis and prognosis. 

If you would like assistance in determining your eligibility or have questions about service and your situation please contact us Here.

Cancer

When is a cancer patient eligible for hospice care?

While a cancer patient’s primary goal is long-term control of the malignancy and a return to health, there may come a time when the cancer can no longer be controlled or when the response to treatment is less than hoped for. Hospice care for a cancer patient focuses entirely on quality of life and is designed to address a wide range of issues, including pain management, weight loss, and progression of the other symptoms. Nightingale Hospice provides the emotional and spiritual support that cancer patients and their loved ones seek-all specific to the individual patient’s needs.

COPD and Lung Disease

Hospice Eligibility: End-Stage COPD and Other Forms of Lung Disease

Major characteristics:

  • Short of breath at rest or with minimal exertion

  • Short of breath after use of an inhaler or a breathing treatment

  • Frequent need for medical services including ER visits and hospitalizations

  • Frequent episodes of bronchitis or pneumonia

  • Unintentional weight loss

  • Progressive inability to independently perform ADL’s (activities of daily living such as bathing or dressing)

Heart Disease

When is a Heart Disease Patient Eligible for Hospice Services?

Patients are eligible for hospice care when a physician makes a clinical determination that life expectancy is six months or less if the disease runs its expected course.

Comorbid disease risk factors:

  • Hypertension

  • Diabetes

  • Coronary heart disease

  • Family history of cardiomyopathy

  • Prior myocardial infarction

  • Valvular heart disease

HIV and AIDS

What are the hospice eligibility guidelines for patients with end-stage HIV/AIDS?

Patients are in the terminal stage of their illness when they are given a life expectancy of six months or less. They must meet the below criteria:

CD4+ count <25

Cells/mm3 or persistent viral load >100,000 copies/ml

PLUS, one of the following:

  • CNS lymphoma

  • Untreated or unresponsive to treatment; wasting with loss of 33% lean body mass

  • Mycobacterium avium complex (MAC) bacteremia untreated or unresponsive to treatment

  • Progressive multifocal leukoencephalopathy

  • Systemic lymphoma with advanced HIV disease and partial response to chemotherapy

  • Visceral Kaposi’s sarcoma unresponsive to therapy

  • Renal failure in the absence of dialysis

  • Cryptosporidium infection

  • Toxoplasmosis unresponsive to therapy

  • Cytomegalovirus (CVM) infection

Liver Disease

When is the Liver Disease Patient Eligible for Hospice Services?

Physicians may use clinical guidelines to identify patients in the final six months of liver disease. When it comes to end-of-life care, patients should be physiologically and psychologically hospice-appropriate.

Liver patients will have:

  • Multiple hospitalizations, ER visits, and increased need for other healthcare services

  • Increased need for physician assessments, lab tests, and diagnostic studies

  • Several comorbid conditions such as diabetes, chronic kidney disease, heart disease)

Renal Disease

Hospice Eligibility Guidelines for End-Stage Renal Disease (ESRD)

When a patient is diagnosed with ESRD, the question the nephrologist or attending physician asks is, “What is the goal of care?” The goal is either to provide dialysis to maintain or improve function OR to provide palliative care.

Patients with ESRD are increasingly characterized by older age and multiple comorbid illnesses. They have a mortality rate eight times higher than the general Medicare population. Dialysis patients are appropriate for palliative care because of their high mortality rate and high symptom burden. More patients and families are choosing to withdraw dialysis for many reasons, particularly in patients older than 60 years. Advance directives are important in ensuring compassionate and goal-directed palliative care of ESRD patients. Making these choices is often an emotionally tiring process. Nightingale Hospice offers emotional and spiritual support for patients and their loved ones.

Sepsis

Hospice Admission Guidelines for Patients with Sepsis

Sepsis is a life-threatening illness brought on by the body’s response to an infection. Sepsis can lead to severe sepsis (acute organ dysfunction related to a suspected infection) and septic shock (severe sepsis plus hypotension not reversed with fluids.)

Patients with post-sepsis usually:

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  • Have increased functional limitations

  • Difficulty swallowing

  • More cardiac issues

  • Elevated risk of recurring sepsis

  • Increased risk of cognitive impairment

  • Experience more depression and anxiety

  • Exacerbation of chronic medical conditions

 

The team at Nightingale Hospice will collaborate with the patient to develop a plan of care for comfort care and symptom management for the chronic sepsis patient.

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