Basic Admission Criteria
Terminal illness
with a prognosis of < 6 months or less should disease take its expected course
Decline in functional status as determined by: Karnofsky Performance status of < 50% Dependence in 3 out of 6
ADL's
Multiple ER visits / inpatient hospitalizations in past 6 months Weight
loss of > 10% over prior 4-6 months Scrum Albumin level < 2.5gm/dl
Patient
or caregiver has elected to receive no further curative measures
Documented clinical
progression of disease
Failure to Thrive_______________________________
Patient has multiple medical conditions and does not meet all criteria for one
specific hospice diagnosis but is showing a decline in functional status:
•
Weight loss of > 10% of body weight over last 6 months
•
Dependence in at least 3 out if 6 ADL's
• Multiple
ER visits in last 6 months
• Compromised or declining
cognitive abilities
Neurological Disease (ES Alzheimers, ES Dementia)
1 Inability to ambulate w/o assistance
2 Inability to bathe or dress without assistance
3 Incontinent of bowel or bladder
4
Multiple decubitus ulcers, state III or IV
5
Frequent infections
6 Speech limited to ~
< 6 intelligible different words
7 At
or beyond stage 7 of functional assessment
8
Hx of dysphagia
9 Weight loss of > 10%
over prior 6 months
10
Serum albumin > 2.5gm/dl
AIDS_________________________________________
1 Antiviral therapy treatment failure
2 Wasting syndrome
3
Dementia
4 Leukoencephalopathies
5 Secondary malignancies (i.e. Kaposi's lymphomas, leukemia's
and ES cervical cancer)
6 CD4 count below
25 cells/McL
7 Viral load > 100,000
