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WHERE DO I START?

When you or a loved one is diagnosed with a serious or advanced illness, figuring out the next steps or where to start can be overwhelming. You may also feel a mix of emotions that can compound the stress and confusion. But learning about your choices and options can help relieve anxiety for you and your family. Talking about your values and goals and determining what information and resources you and your family need can help provide a roadmap for making informed decisions about your plan of care. Read the following pages to learn more about having these important conversation with your family or physician.

WHEN IS THE RIGHT TIME TO CALL?

It’s never too soon to learn more about your options. Hospice works best and is most beneficial when it is started early, so that the patient and family can receive the maximum amount of care and support. Below are a few questions that may indicate that it’s time to consider hospice or palliative care:

  • Have you or your loved one…
  • Seen a progression of a serious illness?
  • Had repeat trips to the hospital?
  • Had increased episodes of pain?
  • Had several falls in the last six months?
  • Had significant, unexplained weight loss?
  • Started spending most of the day in a chair or bed?
  • Had shortness of breath or difficulty breathing?
  • Started to feel that treatment is becoming more of a burden than a benefit?

If you answered yes to two or more of these questions, hospice care could help you. Anyone—a patient, family member, friend, clergy or community member—can request an evaluation for hospice services. Our community and clinical liaisons will ask a few questions, consult with the patient’s physician, and then come to wherever the patient lives (private residence, skilled nursing facility, assisted living community, board and care, etc.) to meet the patient and discuss options for care.


Call 310-817-5665 to learn more or fill out


Patient Care Services

24/7 RN and CHHA, On-Call Physician, Social Worker, Chaplain, & Volunteers

hospice criteria


ADMISSION CRITERIA

Two or more items in any category should generate a hospice referral.

Please call our office at 310-817-5665 or fill out our secure online referral form.

GENERAL GUIDELINES

  • Life-limiting condition
  • Patient/family focus on symptom relief rather than cure
  • Progression of disease(s)
  • Evidence of weight loss; serum albumin < 2.5g/dl
  • Symptoms & signs that paint a picture of decline
  • Karnofsky or Palliative Performance Scale score < 50%
  • Dependence in at least 2 ADLs
  • Need for frequent hospitalization, office or ER visits
  • Progressive/unhealing stage III or IV pressure ulcers

CANCER

  • Clinical findings of malignancy with widespread, aggressive or progressive disease as evidenced by increasing symptoms, worsening lab values and/or evidence of metastatic disease
  • Impaired performance on Palliative Performance Scale of <70%
  • Refuses further curative therapy or continues to decline despite definitive therapy. Decline evidenced by:
  • Hypercalcemia > or = 12
  • Cachexia or weight loss of 5% in the preceding 3 months
  • Recurrent disease after surgery/radiation/chemotherapy
  • Refusal to pursue additional curative or prolonging cancer treatment
  • Signs and symptoms of adcanced diesease (nausea, anemia, malignant ascites or pleural effusion, etc.)

PULMONARY DISEASE

  • Severe chronic lung disease
  • Disabling dyspnea at rest, poorly responsive to bronchodilators
  • FEV1 after bronchodilator < 30%
  • Progression of end-stage pulmonary disease
  • Recurrent pulmonary infections
  • Hypoxemia at rest, on room air: pO2 < 55mmHg – or O2 sat < 88%
  • Right heart failure secondary to pulmonary disease
  • Unintentional progressive weight loss >10%
  • Persistent resting tachycardia

STROKE AND COMA

  • Karnofsky Performance < 40%
  • Inability to maintain nutrition/hydration
  • Weight loss > 10%, serum albumin < 2.5 gm/dl, pulmonary
  • aspiration, severe dysphagia
  • Coma with any 3 of the following on day 3 of coma
  • Abnormal brain stem response
  • Absent verbal response
  • Absent withdrawal response to pain
  • Serum creatinine > 1.5 mg/dl

CARDIAC DISEASE

  • Symptomatic despite optimal treatment with diuretics and vasodilators
  • Recurrent CHFEjection fraction < 20%
  • New York Heart Association Class IV
  • Supporting factors
  • Arrhythmias are resistant to treatment
  • History of cardiac arrest or resuscitation
  • History of unexplained syncope
  • Cardiogenic embolic disease (e.g., CVA)

RENAL DISEASE – ACUTE RENAL FAILURE

  • Patient is not seeking dialysis or transplant
  • Creatinine > 8mg/dl (> 6mg/dl for diabetics)
  • GFR < 10ml/min
  • Creatinine clearance <10cc/min (<15cc/min for diabetics)
  • Co-morbid conditions

RENAL DISEASE – CHRONIC RENAL FAILURE

  • Patient is not seeking dialysis or transplant
  • Creatinine clearance <10cc/min (<15cc/min for diabetics)
  • Creatinine > 8mg/dl (> 6mg/dl for diabetics); GFR < 10ml/min
  • Symptoms: uremia; oliguria; confusion; nausea; vomiting; pruritus; restlessness; hyperkalemia > 7.0,
  • not responsive to treatment; intractable fluid overload, not responsive to treatment

LIVER DISEASE

  • PTT > 5 seconds over control
  • Serum Albumin < 2.5gm/dl
  • End-stage liver disease
  • Ascites refractory to treatment
  • Spontaneous bacterial peritonitis
  • Hepatorenal syndrome
  • Hepatic encephalopathy, refractory to treatment
  • Supportive factors
  • Progressive malnutrition
  • Continued alcoholism
  • Hepatocellular carcinoma

DEMENTIA

  • Functional Assessment score = 7Unable to ambulate without assist
  • Unable to dress or bathe without assist
  • Urinary and fecal incontinence, intermittent or constant
  • No consistently meaningful verbal communication
  • Complications such as aspiration pneumonia, UTI, septicemia, recurrent fevers
  • Decubitus ulcers stage 3 or 4
  • Weight loss of >10% over last six months

ALS

  • Critically impaired respiratory function
  • Dyspnea at rest
  • Use of accessory muscles
  • Respiratory rate > 20
  • Reduced speech / vocal volume
  • Unexplained headaches, anxiety or nausea
  • Severe nutritional insufficiency
  • Progressive weight loss of at least 5% of body weight
  • With or without gastrostomy tube insertion

HIV

  • CD4 count < 25 cells/mcl or persistent viral load >100,000 copies/ml
  • Decreased performance status
  • Supporting factors
  • Chronic persistent diarrhea
  • Persistent serum albumin < 2.5
  • Concomitant substance abuse
  • Age > 50
  • Advanced AIDS dementia complex
  • CHF or advanced liver disease
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