For Referring Doctors

For Referring Doctors

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TRANSITION TO HOSPICE CARE

Qualifying patients for the hospice benefit includes evaluation of multiple factors. Hospice clinicians are available to assist with assessing individual patient's eligibility. Your local Carilion Clinic Hospice can make an informational home or facility visit and provide education regarding hospice services and assess the patient for eligibility.

General Guidelines

Consider hospice for any patient who has an accelerating decline, which may include any of the following:

  • Disease is progressive
  • Decline in functional status or activities of daily living (considerable assistance required)
  • Frequent hospitalizations or ER visits
  • Poor nutritional state such as weight loss, low serum albumin, or loss of muscle mass
  • Multiple significant co-morbidities
  • Recent serious illnesses

ADMISSION GUIDELINES BY DISEASE

ALS (Amyotrophic lateral sclerosis)

  • Significant functional decline
  • Patient or family does not want ventilator

Congestive Heart Failure

  • Frequent hospitalizations or ER visits
  • Dyspnea at rest or edema/rales despite treatment
  • Further disease-modifying therapy declined
  • Poor functional status
  • Any of the following: arrhythmias, syncope, chronic kidney disease, COPD, or other co-morbidities

Cancer

  • Recurrent or progressive disease or advanced stage/metastasis
  • Further aggressive therapy declined

Dementia (Alzheimer's, vascular, or others)

  • Dependent in most activities of daily living
  • Incontinence
  • Limited meaningful speech
  • Dementia related illness within prior six months such as pneumonia, UTI, sepsis, decubiti, and malnutrition
  • Any significant co-morbid disease such as heart failure, coronary artery disease, or COPD

Liver Disease (May remain on the liver transplant list)

  • End-stage liver disease by laboratory or MELD criteria
  • Has had any of the following: ascites, peritonitis, hepatorenal syndrome, or hepatic encephalopathy

Lung Disease

  • Severe chronic lung disease with poor functional status
  • Oxygen dependence with persistent dyspnea at rest
  • Progression of disease noted by frequent hospitalizations or ER visits
  • Does not want a ventilator

Renal Disease

  • Chronic kidney disease, stage V (Diabetic patients are eligible with a higher Creatinine clearance)
  • Stops or declines dialysis
  • Co-morbidities such as heart failure, COPD, or peripheral vascular disease

Stroke/Coma

  • Prior CVAs with declining functional and nutritional status
  • Coma or persistent vegetative state secondary to stroke for more than three days duration