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Is My Loved One Hospice Eligible?

Know the signs of when hospice is may be the right time. With Ohio Valley Hospice, we tailor a customized care plan that meets the unique needs of the specific condition or illness.

Our Mission to Find the Right Care Plan

A person experiencing symptoms relating to Alzheimer’s Disease should have different care provided than an individual with a heart condition. Each person is different, and their care plan should be reflective based on the special care they need for their life-limiting illness or condition.

The following information can be used to help determine if it is the right time to consider hospice. 

An Overview of Hospice Care by Dr. Laura Mantine

Alzheimer's Disease

Hospice can help those experiencing symptoms relating to Alzheimer’s Disease and forms of dementia by controlling pain, relieving anxiety, and improving quality of life.

Here are a few signs that may lead to hospice eligibility:

  • The patient is at or beyond stage 7 of the Functional Assessment Staging (FAST) scale
  • Inability to ambulate (move) independently, requiring assistance
  • Unable to bathe or dress self without assistance
  • Incontinence of bowel and/or bladder
  • Unable to speak or communicate meaningfully

Here are also a few criteria that could relate to complications due to dementia. Has your loved one experienced one or more of the following in the past year:

  • Aspiration Pneumonia
  • Urinary Tract Infection (UTI)
  • Septicemia
  • Decubitus Ulcer, stage 3-4
  • Recurrent fever after antibiotic treatment
  • Inability or unwillingness to take food or fluids
  • Unintentional weight loss, more specifically, greater than 10% in the last 6 months
  • Serum albumin, less than 2.5 gm/dl

Cancer

As there are many different types of cancer, the following hospice cancer criteria are general rules used to determine if hospice is the right choice for a patient.

Clinical hospice cancer criteria may include:

  • A metastatic cancer diagnosis
  • Demonstrates decline in condition in spite of therapy efforts
  • Received a Palliative Performance Score or Karnofsky Score of 70% or less by a primary care physician
  • Electing to forgo further disease-directed curative treatment
If a cancer patient is eligible for hospice, the Apreva Hospice team provides comprehensive symptom management for a wide range of cancer-related issues. It is important to start the hospice conversation as early as possible, giving you the time to explore all available options and to gather what information you may need before a crisis occurs.

Chronic Obstructive Pulmonary Disease (COPD)

When an individual begins to experience one or more of the following criteria, it may be time to bring on the additional support of hospice care.

  • Recent visits to the ER or hospitalization for pulmonary infections or respiratory failure
  • Dyspnea, or tightness in the chest
  • Identification of specific structural/functional impairments
  • Relevant activity limitations
  • Changes in appetite and unintentional & progressive weight loss
  • Impaired sleep functions
  • Decline in general physical endurance
  • Impaired mobility
  • Requires oxygen some or all of the time
  • Requires breathing treatments or use of inhalers
  • Difficulty eating or carrying on conversations without becoming short of breath

Individuals with other types chronic lung or restrictive airway diseases may be experiencing the following:

  • Disabling dyspnea at rest
  • Poorly unresponsive to bronchodilators resulting in decreased functional capacity
  • Increased visits to the ER or hospitalized for pulmonary infections and/or respiratory failure

Any of these criteria can also be accompanied by:

  • Persistent hypercapnia (pCO2 greater than or equal to 50 mmHg)
  • Cor Pulmonale, or right heart failure (Secondary to pulmonary disease)
  • Resting tachycardia, less than 100 bpm
  • Has become steroid-dependent
  • Unintentional progressive weight loss of greater than 10% body weight in past 6 months.

Cerebrovascular Accident (Stroke)

The following criteria could be indicators that it may be a good time to consider the additional support of hospice. 

Have you noticed any of the following in recent months:

  • Have received a Palliative Performance Score, or Karnofsky Score, of 40% or less from a primary care physician
  • Mainly bed or wheelchair bound
  • Increasiningly impaired functional status, requiring assistance remembering daily tasks or routines
  • Requires assistance with activities of daily life (ADLs)
  • Unable to maintain sufficient fluid and caloric intake with a decrease in eating or drinking
  • Demonstrates progressive weight loss

General Requirements for Hospice Eligibility

General Decline in Health

Sometimes end-of-life is presented an an overall decline in health for hospice patients. 

Do any of the following apply:

  • Have been hospitalized or visited the ER multiple times in the past 6 months
  • Fallen on several occasions over the past 6 months
  • Experienced weight loss, which has made clothes look noticeably looser
  • Decrease in appetite
  • Started medication for pain management
  • Spends most of the day in a chair or bed
  • Started needing help with Activities of Daily Life (ADLs)
  • Reports a loss of energy or are sleeping more
  • Noticing a shortness of breath, even while resting

Chronic Heart Failure, or Heart Disease

Individuals with CHF or other types of end-stage cardiac conditions are good indications of hospice eligibility.

  • Identification of specific structural/functional impairments
  • An ejection fraction of less than 20% (This is not a requirement, but is an important consideration)
  • A poor response to diuretics and vasodilators
  • Dyspnea, or tightness in the chest
  • Expressing chest pain
  • Impaired heart rhythms, contraction force of ventricular muscles, and impaired blood supply to the heart
  • Changes in appetite, unintentional weight loss
  • Impaired sleep functions, changes in sleeping patterns
  • Decline in general physical endurance
  • Relevant activity limitations and or impaired mobility

Liver Disease

Look for these signs that come to a point that all involved may benefit from hospice services:

  • Weakness and compromised ability perform Activities of Daily Life (ADLs)
  • Recurrent variceal hemorrhages
  • Hepatic encephalopathy
  • Prothrombin time prolonged more than five seconds over control (INR > 1.5)
  • Serum Albumin < 2.5 gm/dl
  • Diagnosed with Peritonitis
  • Elevated creatinine and BUN with Oliguria <400 ml/day and urine sodium concentration <10 mEq/l
  • Ascites
  • Asterixis
  • Demonstrates malnutrition or muscles wasting

Decline in Neurological Condition

Due to the progressive nature of neurological conditions associated with non-Alzheimer’s dementia, such as Parkinsons, MS, ALS, Huntington’s Disease, and others, it can be challenging for families to know the right time for hospice support. Apreva Hospice is available for family/patient informational discussions to determine what is right for you.

  • Impaired mental function
  • Impaired sensory function and pain
  • Impaired neuromusculoskeletal and movement functions
  • Impaired communication or unintelligible speech
  • Impaired mobility and/or rapid progression to becoming wheelchair or bed bound
  • Self-care deficit, or inability to perform Activities of Daily Living (ADLs)
  • Dyspnea at rest, or requiring supplemental oxygen at rest
  • Inability to eat or drink sufficiently
  • Additional comorbidities or complications that exacerbate the degenerative neurological condition, including pneumonia, sepsis, pyelonephritis, or decubitus ulcers

Make the Choice of Quality End of Life

Ohio Valley Hospice is the right choice for the best quality of care for you and your loved ones.

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