Hospice: Do I Qualify?

You Or A Loved One May Need Hospice If…

Faced with a life-limiting illness where aggressive treatments and medications are no longer beneficial.  We have included the following questionnaire to help you identify if you or your loved one can benefit from our hospice services:

Have you or your loved one…

  • been hospitalized or gone to the emergency room several times in the past six months?
  • been making more frequent phone calls to your physicians?
  • started taking medication to lessen physical pain?
  • started spending most of the day in a chair or in bed?
  • fallen several times over the past six months?
  • started needing help from other with: bathing, dressing, eating, cooking, getting out of bed, or walking?
  • started feeling weaker or more tired?
  • experienced weight loss so that clothes are noticeably looser?
  • noticed a shortness of breath, even while resting?
  • been told by a doctor that life expectancy is limited?

Adapted from NHPCO

If you answered “yes” to four or more of these questions, then you or your loved one could be eligible for hospice care. Superior Hospice can help manage the physical, emotional, and spiritual needs of the patient and support the needs of the family/friends support system as they deal with issues related to their loved one’s life-limiting illness.  We understand every situation is different, and 0ur compassionate team will be there every step of the way during this challenging time. The earlier we join you in this process, the more resources we can provide to create a supportive experience.

Signs & Symptoms

This following table can help determine if a patient or loved one is hospice appropriate and meets hospice criteria. The following signs and symptoms listed for each diagnosis are not all inclusive. They should be used as a guide to determine prognosis. In the absence of one or more of these findings, rapid decline or comorbidities may also support eligibility for hospice care.

  • Fast scale of Stage 7C or beyond
  • Inability to ambulate without assistance
  • Inability to dress without assistance
  • Urinary and fecal incontinence, intermittent or constant
  • No consistent meaningful/reality based verbal communications, stereotypical phrases or the ability to speak is limited to a few intelligible words
  • Aspiration pneumonia within the last 12 months
  • Pyelonephritis or other upper urinary tract infection
  • Septicemia
  • Decubitus ulcers, Multiple and/or stage 3-4
  • Fever, recurrent after antibiotics
  • Inability to maintain sufficient fluid and caloric intake demonstrated by either of the following:
    • 10% weight loss during the previous six months
    • Serum albumin <2.5 gm/dl
  • Dyspnea at rest
  • Vital capacity less than 30%
  • The requirement of supplement oxygen at rest
  • The patient declines artificial ventilation
  • Decline from independent to wheelchair/bedbound status
  • Decline from normal to pureed diet
  • Oral intake of nutrients and fluid insufficient
  • Continuing weight loss
  • Dehydration or hypovolemia
  • Recurrent aspiration pneumonia
  • Stage 3 or Stage 4 decubitus ulcer(s)
  • Clinical findings of malignancy with widespread, aggressive, or progressive disease as evidenced by increase symptoms, worsening lab values and/or evidence of metastatic disease
  • Palliative Performance <70%
  • Refuses curative therapy or continues to decline despite definitive therapy
  • Hypercalcemia >12
  • Cachexia or weight loss of 5% in 3 months
  • Recurrent disease after surgery/radiation/chemo
  • Refusal to pursue additional curative or prolonging cancer
  • Signs and symptoms of advance disease
  • Disabling Dyspnea at rest
  • Poor response to bronchodilators
  • Decreased functional capacity (ie. Bed to chair existence, fatigue and cough)
  • An FEV1 <30% is objective evidence for disabling dyspnea but is not required AND
  • Progression of disease as evidenced by a recent history of increase visits to MD office, home or emergency room and/or hospitalizations for pulmonary infection and/or respiratory failure AND
  • Documentation within the past three (3) months of a or b or both:
    • Hypoxemia at rest (pO2<55mgHg by ABG) or oxygen saturation <88%
    • Hypercapnia evidence by pC02>55mm Hg
  • Cor pulmonale and right heart failure secondary to pulmonary disease
  • Unintentional progressive weight loss >10% over the preceding six (6) months
  • Resting tachycardia >100bpm
  • Poor response to (or patients/loved one’s choice to not pursue) optimal treatment with diuretics, vasodilators, and/or angiotensin converting enzyme inhibitors
  • Angina pectoris at rest resistant to standard nitrate therapy and is not a candidate for invasive procedures and/or has declined revascularization procedures
  • NYHA Class IV CHF
  • Ejection fraction 20% or less
  • Treatment resistant symptomatic dysrhythmias
  • CVA secondary to cardiac embolism
  • History of cardiac arrest or resuscitation
  • CD4+ Count <25 cells/mm or persistent viral load >100,000 copies/ml from 2 or more assays at least 1 month apart

AND

  • At least one of the following conditions:
    • CNS lymphoma
    • Untreated or refractory wasting loss of >33% lean body mass
    • Mycobacterium avium complex (MAC) bacteremia, untreated, refractory or treatment refused
  • Progressive multifocal leukoencephalopathy
  • Systemic lymphoma
  • Refractory visceral Kaposi’s sarcoma
  • Renal failure in the absence of dialysis
  • The patient has both 1 and 2:
    • Stage 7 or beyond according to the Functional Assessment Staging Scale with all of the following:
      • Inability to ambulate without assistance
      • Inability to dress without assistance
      • Urinary and fecal incontinence, intermittent or constant
      • No consistent meaningful verbal communication
    • AND 2. Has had at least one of the following conditions within the past 12 months:
      • Aspiration pneumonia
      • Pyelonephritis or other upper urinary tract infection
      • Septicemia
      • Multiple Stage 3 or Stage 4 pressure ulcers
      • Toxoplasmosis unresponsive to therapy
      • Fever, recurrent after antibiotics
      • Inability to maintain sufficient fluid and caloric intake with one or more of the following during the preceding 12 months:
        • 10% weight loss during the previous six months OR
        • Serum albumin
  • Prothrombin time PTT prolonged more than five (5) seconds over control or INR>1.5
  • Serum albumin <2.5gm/dl
  • End-stage liver disease is present, and the patient has one or more of the following conditions:
    • Ascites, refractory to treatment or patient declines or is non-compliant
    • History of spontaneous bacterial peritonitis
    • Hepatorenal syndrome (elevated creatinine with oliguria <400ml/day)
    • Hepatic encephalopathy, refractory to treatment or patient non-compliant
    • History of recurrent variceal bleeding despite intensive therapy or patient declines therapy
  • Progressive malnutrition
  • Muscle wasting with reduced strength
  • Ongoing alcoholism (.80gm ethanol/day)
  • Hepatocellular carcinoma
  • Hepatitis B surface antigen positive
  • Hepatitis C refractory to interferon treatment
  • Severely impaired breathing capacity with all of the following findings:
    • Dyspnea at rest
    • Vital capacity less than 30%
    • The requirement of supplement oxygen at rest
    • The patient declines artificial ventilation
    • Decline from Independent to wheelchair/bedbound status
    • Decline from normal to pureed diet
    • Oral intake of nutrients and fluid insufficient
    • Continuing weight loss
    • Dehydration or hypovolemia
    • Recurrent aspiration pneumonia
  • Severely impaired breathing capacity
  • Dyspnea at rest
  • Vital capacity less than 30%
  • Progression from independent ambulation to wheelchair/bed bound
  • Progression from normal to barely intelligible or unintelligible speech
  • Oral intake of nutrients/fluids insufficient to sustain life
  • Recurrent aspiration pneumonia
  • Upper urinary tract infection
  • Sepsis
  • Recurrent fever after antibiotic therapy
  • Creatinine clearance <10cc/min and <15cc/min for diabetics
  • Serum creatinine >8.0 and 6.0 in diabetics
  • Not seeking dialysis or transplant
  • Uremia
  • Oliguria (urine output is less than 400cc in 24 hours)
  • Intractable hyperkalemia (greater than 7.0) not responsive to treatment
  • Uremia pericarditis
  • Hepatorenal syndrome
  • Immunosuppression/AIDS
  • Intractable fluid overload, not responsive to treatment
  • Severely impaired breathing capacity
  • Dyspnea at rest
  • Vital capacity less than 30%
  • The requirement of supplemental oxygen at rest
  • The patient declines artificial ventilation
  • Progression from independent ambulation to wheelchair/bed bound
  • Progression from normal to barely intelligible or unintelligible speech
  • Oral intake of nutrients/fluids insufficient to sustain life
  • Continuing weight loss
  • Dehydration or hypovolemia
  • Absence of artificial feeding
  • Recurrent aspiration pneumonia
  • Upper urinary tract infection
  • Sepsis
  • Recurrent fever after antibiotic therapy
  • Stage 3 or 4 decubitus ulcer(s)
  • Palliative Performance Scale 40% or less
  • Body Mass Index <22
  • Unintentional weight loss (despite tube feeding); 10% in 6 months
  • Dysphagia without tube feeding
  • Pulmonary aspiration not responsive to speech pathology intervention
  • Age >70
  • Post stroke dementia, with FAST score of 7C or >
  • Medical complications related to progressive clinical decline
  • Aspiration pneumonia
  • UTIs
  • Sepsis
  • Skin breakdown; decubitus ulcers; refractory stage 3-4

If your loved one meets the criteria above, they are eligible for our services. We offer an easy Self-Referral program that you can do over the phone. Follow the button below to go straight to our referrals page.

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If you have any further questions or concerns, please feel free to reach out to us.

Please Note: By completing this form, you agree to receive information from Superior. Your privacy is very important to us. Read our privacy policy for more info.

Connect Now

If you have any further questions or concerns, please feel free to reach out to us.

Please Note: By completing this form, you agree to receive information from Superior. Your privacy is very important to us. Read our privacy policy for more info.