Is My Loved One Hospice Eligible?

Know the signs of when hospice is may be the right time. With At-Heart HomeCare & Hospice, we will tailor a customized care plan that meets the unique needs of the specific condition or illness.

Our Mission to Find the Right Care Plan

A person experiencing symptoms relating to Alzheimer’s Disease should have different care provided than an individual with a heart condition. Each person is different, and their care plan should be reflective based on the special care they need for their life-limiting illness or condition.

The following criteria for hospice can be used to help determine if it is the right time to consider hospice.

An Overview of Hospice Care by Dr. Laura Mantine

Alzheimer's Disease

Hospice can help those experiencing symptoms relating to Alzheimer’s Disease and forms of dementia by controlling pain, relieving anxiety, and improving quality of life.

Here are a few signs that may lead to hospice eligibility:

The patient is at or beyond stage 7 of the Functional Assessment Staging (FAST) scale
Inability to ambulate (move) independently, requiring assistance
Unable to bathe or dress self without assistance
Incontinence of bowel and/or bladder
Unable to speak or communicate meaningfully

Here are also a few criteria that could relate to complications due to dementia. Has your loved one experienced one or more of the following in the past year:

Aspiration Pneumonia
Urinary Tract Infection (UTI)
Septicemia
Decubitus Ulcer, stage 3-4
Recurrent fever after antibiotic treatment
Inability or unwillingness to take food or fluids
Unintentional weight loss, more specifically, greater than 10% in the last 6 months
Serum albumin, less than 2.5 gm/dl

Cancer

As there are many different types of cancer, the following hospice cancer criteria are general rules used to determine if hospice is the right choice for a patient.

Clinical hospice cancer criteria may include:

A metastatic cancer diagnosis
Demonstrates decline in condition in spite of therapy efforts
Received a Palliative Performance Score or Karnofsky Score of 70% or less by a primary care physician
Electing to forgo further disease-directed curative treatment

If a cancer patient is eligible for hospice, the At-Heart HomeCare & Hospice team provides comprehensive symptom management for a wide range of cancer-related issues. It is important to start the hospice conversation as early as possible, giving you the time to explore all available options and to gather what information you may need before a crisis occurs.

Chronic Obstructive Pulmonary Disease (COPD)

When an individual begins to experience one or more of the following criteria, it may be time to bring on the additional support of hospice care.

Recent visits to the ER or hospitalization for pulmonary infections or respiratory failure
Dyspnea, or tightness in the chest
Identification of specific structural/functional impairments
Relevant activity limitations
Changes in appetite and unintentional & progressive weight loss
Impaired sleep functions
Decline in general physical endurance
Impaired mobility
Requires oxygen some or all of the time
Requires breathing treatments or use of inhalers
Difficulty eating or carrying on conversations without becoming short of breath

Individuals with other types chronic lung or restrictive airway diseases may be experiencing the following:

Disabling dyspnea at rest
Poorly unresponsive to bronchodilators resulting in decreased functional capacity
Increased visits to the ER or hospitalized for pulmonary infections and/or respiratory failure

Any of these criteria can also be accompanied by:

Persistent hypercapnia (pCO2 greater than or equal to 50 mmHg)
Cor Pulmonale, or right heart failure (Secondary to pulmonary disease)
Resting tachycardia, less than 100 bpm
Has become steroid-dependent
Unintentional progressive weight loss of greater than 10% body weight in past 6 months.

Cerebrovascular Accident (Stroke)

The following criteria could be indicators that it may be a good time to consider the additional support of hospice.

Have you noticed any of the following in recent months:

Have received a Palliative Performance Score, or Karnofsky Score, of 40% or less from a primary care physician
Mainly bed or use of wheelchair
Increasiningly impaired functional status, requiring assistance remembering daily tasks or routines
Requires assistance with activities of daily life (ADLs)
Unable to maintain sufficient fluid and caloric intake with a decrease in eating or drinking
Demonstrates progressive weight loss

General Requirements for Hospice Eligibility

General Decline in Health

Sometimes end-of-life is presented an an overall decline in health for hospice patients.

Do any of the following apply:

Have been hospitalized or visited the ER multiple times in the past 6 months
Fallen on several occasions over the past 6 months
Experienced weight loss, which has made clothes look noticeably looser
Decrease in appetite
Started medication for pain management
Spends most of the day in a chair or bed
Started needing help with Activities of Daily Life (ADLs)
Reports a loss of energy or are sleeping more
Noticing a shortness of breath, even while resting

Chronic Heart Failure, or Heart Disease

Individuals with CHF or other types of end-stage cardiac conditions are good indications of hospice eligibility.

Identification of specific structural/functional impairments
An ejection fraction of less than 20% (This is not a requirement, but is an important consideration)
A poor response to diuretics and vasodilators
Dyspnea, or tightness in the chest
Expressing chest pain
Impaired heart rhythms, contraction force of ventricular muscles, and impaired blood supply to the heart
Changes in appetite, unintentional weight loss
Impaired sleep functions, changes in sleeping patterns
Decline in general physical endurance
Relevant activity limitations and or impaired mobility

Liver Disease

Look for these signs that come to a point that all involved may benefit from hospice services:

Weakness and compromised ability perform Activities of Daily Life (ADLs)
Recurrent variceal hemorrhages
Hepatic encephalopathy
Prothrombin time prolonged more than five seconds over control (INR > 1.5)
Serum Albumin < 2.5 gm/dl
Diagnosed with Peritonitis
Elevated creatinine and BUN with Oliguria <400 ml/day and urine sodium concentration <10 mEq/l
Ascites
Asterixis
Demonstrates malnutrition or muscles wasting

Decline in Neurological Condition

Due to the progressive nature of neurological conditions associated with non-Alzheimer’s dementia, such as Parkinsons, MS, ALS, Huntington’s Disease, and others, it can be challenging for families to know the right time for hospice support. At-Heart HomeCare & Hospice is available for family/patient informational discussions to determine what is right for you.

Impaired mental function
Impaired sensory function and pain
Impaired neuromusculoskeletal and movement functions
Impaired communication or unintelligible speech
Impaired mobility and/or rapid progression to becoming wheelchair or bed bound
Self-care deficit, or inability to perform Activities of Daily Living (ADLs)
Dyspnea at rest, or requiring supplemental oxygen at rest
Inability to eat or drink sufficiently
Additional comorbidities or complications that exacerbate the degenerative neurological condition, including pneumonia, sepsis, pyelonephritis, or decubitus ulcers

Make the Choice of Quality Care

At-Heart HomeCare & Hospice is the right choice for the best care for you and your loved ones.

We offer:

Customized care plans, focused on the specific needs of the individual
Coordinated care with an experienced team of professionals
Medical, Social, and Spiritual support
Grief and Bereavement support

Give us a call today to learn more.