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For Health Professionals

End-of-Life Indicators

It is often difficult to determine when a patient may have a life expectancy of six months or less. We provide the following guidelines to assist you in determining if your patient is appropriate for hospice care. They are to be viewed as guidelines and not mandated criteria. We always want to discuss potential referrals with you, so please feel free to call us at 845-634-4974.

General Guidelines (applicable to all diagnoses)

  • Recurrent infections: pneumonia, sepsis, pyleonephritis
  • Multiple hospital or ER visits, increasing MD visits
  • Progressive weight loss >10% in prior six months not attributable to reversible cause
  • Significantly decreased intake, artificial nutrition/hydration declined
  • Non-healing pressure ulcers (Stage III or IV) with or without optimal care
  • HGB<10; Albumin <2.5 when available
  • Ascites or edema
  • Systolic BP below 90 or progressive postural hypotension
  • Unexplained or refractory fevers
  • Changes in level of consciousness
  • Increasing dependence of ADLs
  • Palliative Performance Score <70 or Karnofsky Performance Status <70
  • Symptoms poorly responsive to treatment: dyspnea, cough, nausea, vomiting, pain, diarrhea
  • 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
  • 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

Cardiac Disease

  • New York Heart Association Class IV CHF or Angina (symptoms present at rest; disabling symptoms with minimal exertion; unable to engage in any physical activity without discomfort)
  • Medically optimized with diuretic/vasodilator therapies and supplemental oxygen
  • Patient declined or is not a candidate for surgery
  • Cardiac-specific supporting factors: prior cardiac arrest, unexplained syncope, ejection fraction <20%, treatment-resistant arrhythmia, severe valvular heart disease, brain embolism of cardiac origin, comorbid HIV

Click Here for the HeartWise: Heart Failure Zone Tool

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