{"id":1305,"date":"2021-06-25T15:26:52","date_gmt":"2021-06-25T15:26:52","guid":{"rendered":"https:\/\/unitedhospiceinc.org\/?page_id=1305"},"modified":"2023-06-01T13:49:52","modified_gmt":"2023-06-01T17:49:52","slug":"guideline-for-hospice-referrals","status":"publish","type":"page","link":"https:\/\/unitedhospiceinc.org\/es\/healthcare-professionals\/guideline-for-hospice-referrals\/","title":{"rendered":"Directrices para la remisi\u00f3n de pacientes terminales"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; fullwidth=&#8221;on&#8221; theme_builder_area=&#8221;post_content&#8221; _builder_version=&#8221;4.21.0&#8243; _module_preset=&#8221;default&#8221; da_is_popup=&#8221;off&#8221; da_exit_intent=&#8221;off&#8221; da_has_close=&#8221;on&#8221; da_alt_close=&#8221;off&#8221; da_dark_close=&#8221;off&#8221; da_not_modal=&#8221;on&#8221; da_is_singular=&#8221;off&#8221; da_with_loader=&#8221;off&#8221; da_has_shadow=&#8221;on&#8221; da_disable_devices=&#8221;off|off|off&#8221;][et_pb_nextend_smart_slider_3_fullwidth _builder_version=&#8221;4.21.0&#8243; _module_preset=&#8221;default&#8221; theme_builder_area=&#8221;post_content&#8221; slider=&#8221;18&#8243; hover_enabled=&#8221;0&#8243; sticky_enabled=&#8221;0&#8243;][\/et_pb_nextend_smart_slider_3_fullwidth][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#FFFFFF&#8221; da_disable_devices=&#8221;off|off|off&#8221; global_colors_info=&#8221;{}&#8221; da_is_popup=&#8221;off&#8221; da_exit_intent=&#8221;off&#8221; da_has_close=&#8221;on&#8221; da_alt_close=&#8221;off&#8221; da_dark_close=&#8221;off&#8221; da_not_modal=&#8221;on&#8221; da_is_singular=&#8221;off&#8221; da_with_loader=&#8221;off&#8221; da_has_shadow=&#8221;on&#8221;][et_pb_row column_structure=&#8221;1_2,1_2&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;a95d1291-4312-4432-b9f9-e0f5149ec6ad&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h3>It is often difficult to determine when a patient may have a life expectancy of six months or less.<\/h3>\n<p>[\/et_pb_text][et_pb_text _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p><span style=\"font-weight: 400;\">We have put together the following guidelines to assist you in determining if your patient is appropriate for hospice care. The end of life indicators that are listed below are to be viewed as guidelines and not mandated criteria.\u00a0<\/span><\/p>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_image src=&#8221;https:\/\/unitedhospiceinc.org\/wp-content\/uploads\/2021\/06\/UHR_paying_for_hospice_0819.jpg&#8221; title_text=&#8221;Senior woman getting advice&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; border_radii=&#8221;on|35px|35px|35px|35px&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_image][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;rgba(0,167,181,0.07)&#8221; da_disable_devices=&#8221;off|off|off&#8221; global_colors_info=&#8221;{}&#8221; da_is_popup=&#8221;off&#8221; da_exit_intent=&#8221;off&#8221; da_has_close=&#8221;on&#8221; da_alt_close=&#8221;off&#8221; da_dark_close=&#8221;off&#8221; da_not_modal=&#8221;on&#8221; da_is_singular=&#8221;off&#8221; da_with_loader=&#8221;off&#8221; da_has_shadow=&#8221;on&#8221;][et_pb_row _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_accordion open_toggle_text_color=&#8221;#00A7B5&#8243; open_toggle_background_color=&#8221;#FFFFFF&#8221; closed_toggle_background_color=&#8221;#fcfcfc&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; toggle_text_color=&#8221;#01426A&#8221; toggle_level=&#8221;h4&#8243; toggle_font=&#8221;|600|||||||&#8221; toggle_font_size=&#8221;32px&#8221; border_width_all=&#8221;0px&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_accordion_item title=&#8221;General Guidelines (applicable to all diagnoses)&#8221; open=&#8221;on&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Recurrent infections: pneumonia, sepsis, pyelonephritis<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Multiple hospital or ER visits, increasing MD visits<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Progressive weight loss &gt;10% in prior six months not attributable to reversible cause<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Significantly decreased intake, artificial nutrition\/hydration declined<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Non-healing pressure ulcers (Stage III or IV) with or without optimal care<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">HGB&lt;10; Albumin &lt;2.5 when available<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ascites or edema<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Systolic BP below 90 or progressive postural hypotension<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Unexplained or refractory fevers<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Changes in level of consciousness<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Increasing dependence of ADLs<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Palliative Performance Score &lt;70\u00a0or\u00a0<\/span><a href=\"http:\/\/www.aboutcancer.com\/karnofsky.htm\"><span style=\"font-weight: 400;\">Karnofsky Performance Status &lt;70<\/span><\/a><span style=\"font-weight: 400;\">\u00a0(click for additional information on KPS)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Symptoms poorly responsive to treatment: dyspnea, cough, nausea, vomiting, pain, diarrhea<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Labs (when available but not required): increasing pCO2 or decreasing pO2 or decreasing SaO2, increasing calcium, creatinine or liver function studies, increasing tumor markers (CEA, PSA), progressively decreasing\/increasing serum sodium or increasing potassium<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Co-morbid conditions such as: dementia, COPD, CHF\/ischemic heart disease, diabetes, neurological disease, advanced kidney disease, advanced liver disease, HIV\/AIDS, autoimmune disease, malignancy<\/span><\/li>\n<\/ul>\n<p>[\/et_pb_accordion_item][et_pb_accordion_item title=&#8221;Cancer&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; open=&#8221;off&#8221;]<\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Confirmed diagnosis by pathology or radiology<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patient is no longer receiving\/not a candidate for curative treatment<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Evidence of end stage or metastatic disease<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Recent lab\/diagnostic studies supporting evidence of disease<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Poorly responsive to chemotherapy\/other disease treatment<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Contributing co-morbidities<\/span><\/li>\n<\/ul>\n<p>[\/et_pb_accordion_item][et_pb_accordion_item title=&#8221;Cardiac Disease&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; open=&#8221;off&#8221;]<\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">New York Heart Association Class IV: Symptoms of heart failure or anginal syndrome present at rest, unable to engage in any physical activity<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Medically optimized with diuretics and vasodilators and supplemental oxygen<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ejection fraction &lt;20%<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Patient is not a candidate for or they have declined surgical procedures<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Diagnosis-specific supporting factors: treatment resistant symptomatic supraventricular or ventricular arrhythmias, history of cardiac arrest or resuscitation, history of unexplained syncope, brain embolism of cardiac origin, severe valvular heart disease, comorbid HIV<\/span><\/li>\n<\/ul>\n<p>[\/et_pb_accordion_item][et_pb_accordion_item title=&#8221;Renal Failure&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; open=&#8221;off&#8221;]<\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Not seeking or discontinuing dialysis AND one of the next three criteria:<br \/><\/span>\n<p>&nbsp;<\/p>\n<ul style=\"padding-bottom: 0;\">\n<li style=\"font-weight: 400;\" aria-level=\"2\"><em><span style=\"font-weight: 400;\">Creatinine Clearance &lt;10cc\/min, &lt;15 cc\/min. for diabetics OR for patients with comorbidity of CHF &lt;15cc\/min, &lt;20cc\/min. for diabetic and CHF<\/span><\/em><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><em><span style=\"font-weight: 400;\">Serum creatinine &gt; 8mg\/dl (&gt;6 mg\/dl for diabetics)<\/span><\/em><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\"><em>Estimated glomerular filtration rate (GFR) &lt;10 mL\/min.<br \/><\/em><br \/><\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Uremia<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Oliguria (&lt;400c\/24 hours)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Intractable hyperkalemia (&gt;7.0 mEq\/L) not responsive to treatment<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Uremic pericarditis<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hepatorenal syndrome<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Intractable fluid overload<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Contributing comorbidities: advanced cardiac, liver or lung disease, malignancy or AIDS, albumin&lt;3.5gm\/dl, platelet count &lt;25,000, DIC, GI bleeding, sepsis<\/span><\/li>\n<\/ul>\n<p>[\/et_pb_accordion_item][et_pb_accordion_item title=&#8221;Pulmonary Disease&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; open=&#8221;off&#8221;]<\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Severe chronic lung disease as documented by disabling dyspnea at rest, unresponsive to bronchodilators resulting in decreased functional capacity, ex: bed to chair, fatigue cough. FEV1 after bronchodilator &lt;30% (but not necessary to obtain) AND<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Progression of end stage pulmonary disease by increasing visits to the ER, hospitalizations for pulmonary infections and\/or respiratory failure or arrest. Serial decrease of FEV1 &gt;40ml\/year (not necessary to obtain) AND<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hypoxemia at rest on room air, as evidenced by pO2&lt; or = 55mmHg, oxygen saturation &lt; or= 88% OR pCO2 &gt; or = 50mm Hg determined by ABG or oxygen saturation monitors from recent hospital records.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Resting tachycardia &gt; 100\/min<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Right heart failure secondary to pulmonary disease (cor pulmonale), not secondary to left heart disease or valvulopathy<\/span><\/li>\n<\/ul>\n<p>[\/et_pb_accordion_item][et_pb_accordion_item title=&#8221;Stroke&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; open=&#8221;off&#8221;]<\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Poor nutritional status\/dysphagia severe enough to prevent patient from continuing fluids\/food necessary to sustain life<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Chair or bed bound<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Current history of pulmonary aspiration<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"http:\/\/www.aboutcancer.com\/karnofsky.htm\"><span>Karnofsky Scale<\/span><\/a><span>\u00a0or\u00a0Palliative Performance Scale\u00a0&lt;40<\/span><\/li>\n<\/ul>\n<p>[\/et_pb_accordion_item][et_pb_accordion_item title=&#8221;Coma&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; open=&#8221;off&#8221;]<\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Any three of the following symptoms on day three of the coma: abnormal brain stem response, absent verbal response, absent withdrawal response to pain, serum creatinine 1.5 mg\/dl<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Documentation of the following factors lend support to eligibility:\u00a0<\/span><\/li>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><em><span style=\"font-weight: 400;\">(a) Medical complications, in the context of progressive clinical decline, within the previous 12 mos., which support a terminal diagnosis: aspiration pneumonia, pyelonephritis, refractory stage 3-4 pressure ulcers, fever after recurrent antibiotics\u00a0<\/span><\/em><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><em><span style=\"font-weight: 400;\">(b) diagnostic imaging factors that support a poor prognosis after stroke include: for non traumatic stroke: large volume hemorrhage on CT, infratentorial: &gt; or =20 ml, or supratentorial &gt; or = 50 ml.\u00a0<\/span><\/em><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><em><span style=\"font-weight: 400;\">(c) ventricular extension or hemorrhage: Surface area of hemorrhage &gt; or = 30% of cerebrum, midline shift &gt; or = 1.5cm., or obstructive hydrocephalus in patient who declines , or is not a candidate for ventriculoperitoneal shunt.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/em><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><em><span style=\"font-weight: 400;\">(d) thrombotic\/embolic stroke: large anterior infarcts with both cortical and subcortical involvement, large bihemispheric infarcts, basilar artery occlusion, bilateral vertebral artery occlusion<\/span><\/em><\/li>\n<\/ul>\n<\/ul>\n<p>[\/et_pb_accordion_item][et_pb_accordion_item title=&#8221;Alzheimer&#8217;s Disease\/Dementia&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; open=&#8221;off&#8221;]<\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Beyond Stage 7 of the\u00a0<\/span><span style=\"font-weight: 400;\">Functional Assessment Staging Test<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><span style=\"font-weight: 400;\">(click for information\u00a0on FAST)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">No consistently meaningful verbal communication or word salad<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Cannot eat, walk or sit up without assistance<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">History of progressive weight loss<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Presence of medical complications within the past year: aspiration pneumonia, UTI, pressure ulcers, septicemia, recurrent fevers after antibiotics<\/span><\/li>\n<\/ul>\n<p>[\/et_pb_accordion_item][et_pb_accordion_item title=&#8221;Liver Disease&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; open=&#8221;off&#8221;]<\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">INR&gt;1.5; PT&gt;5 seconds over control<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ascites, recurrent or refractory to treatment<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Spontaneous bacterial peritonitis<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hepatorenal Syndrome (elevated creatinine and BUN with oliguria (&lt;440 ml\/day) and urine sodium concentration &lt; 10mEq\/l)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hepatic Encephalopathy<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Serum Albumin &lt;2.5gm\/dl<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Recurrent variceal bleeding<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Supporting documentation: Progressive malnutrition, muscle wasting, active alcoholism, positive Hep B\/Hep C refractory to treatment, hepatocellular carcinoma<\/span><\/li>\n<\/ul>\n<p>[\/et_pb_accordion_item][et_pb_accordion_item title=&#8221;ALS&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; open=&#8221;off&#8221;]<\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Two factors are critical in determining prognosis: ability to breathe and swallow<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Critically impaired breathing capacity and invasive ventilation declined as indicated by FVC &lt; 40% and at least TWO (if no FVC then at least three of the following), with or without: dyspnea at rest or oxygen dependence at rest, orthopnea, accessory muscle use, paradoxical abdominal motion, respiratory rate &gt;20, speech greatly reduced in quantity, volume, intelligibility, weak cough, sleep disordered breathing (frequent awakening, excessive daytime fatigue), otherwise unexplained headache, confusion, anxiety or nausea<\/span><span style=\"font-weight: 400;\"><br \/><\/span><span style=\"font-weight: 400;\">AND\/OR<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Severe dysphagia and nutritional insufficiency including weight loss &gt;5% with or without artificial nutrition<\/span><\/li>\n<\/ul>\n<p>[\/et_pb_accordion_item][et_pb_accordion_item title=&#8221;HIV Disease&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; open=&#8221;off&#8221;]<\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">CD4 + count below 25 cells\/mcL\u00a0<\/span><b>or\u00a0<\/b><span style=\"font-weight: 400;\">viral load (HIV RNA) &gt; 100,000<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Decreasing performance status, as measured by KPS\/PPS of 50% ( as evidenced by mainly sit\/lie, extensive disease, considerable assistance required and normal or reduced intake)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">One of the following: AIDS-defining illness (ex: lymphoma, cryptosporidiosis, PML.MAC, toxoplasmosis), renal failure. AIDS wasting syndrome (weight loss&gt; 10%)<\/span><\/li>\n<\/ul>\n<p>[\/et_pb_accordion_item][et_pb_accordion_item title=&#8221;Diagnosis supporting factors:&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221; open=&#8221;off&#8221;]<\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">CNS Lymphoma<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Progressive multifocal leukoencephalopathy<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Age &gt; 50<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Chronic persistent diarrhea x 1 year, CHF, advanced AIDS dementia complex, advanced liver disease, active substance abuse, non-compliance with, refusal of, or resistance to antiretroviral\/prophylactic regimen<\/span><\/li>\n<\/ul>\n<p>[\/et_pb_accordion_item][\/et_pb_accordion][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; da_disable_devices=&#8221;off|off|off&#8221; global_colors_info=&#8221;{}&#8221; da_is_popup=&#8221;off&#8221; da_exit_intent=&#8221;off&#8221; da_has_close=&#8221;on&#8221; da_alt_close=&#8221;off&#8221; da_dark_close=&#8221;off&#8221; da_not_modal=&#8221;on&#8221; da_is_singular=&#8221;off&#8221; da_with_loader=&#8221;off&#8221; da_has_shadow=&#8221;on&#8221;][et_pb_row _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p><strong>We enjoy the relationships we establish with healthcare professionals and are always available to discuss potential referrals with you. Please, feel free to call us at <a href=\"tel:845-634-4974\">845-634-4974<\/a>.<\/strong><\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>It is often difficult to determine when a patient may have a life expectancy of six months or less.We have put together the following guidelines to assist you in determining [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":0,"parent":1221,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","inline_featured_image":false,"footnotes":""},"class_list":["post-1305","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Guideline For Hospice Referrals | United Hospice<\/title>\n<meta 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