Presence of a Serious, Chronic Illness
- Declining ability to complete activities of daily living
- Weight loss
- Multiple hospitalizations
- Difficult to control physical or emotional symptoms related to serious medical illness
- Patient, family or physician uncertainty regarding prognosis
- Patient, family or physician uncertainty regarding goals of care
- Patient or family requests for futile care
- DNR order conflicts
- Use of tube feeding or TPN in cognitively impaired or seriously ill patients
- Limited social support and a serious illness
- Patient, family or physician request for information regarding hospice appropriateness
- Patient or family psychological or spiritual distress
Inpatient indicators
- Two or more admissions for symptom management within 6 months
- Multi-organ failure
- Metastatic cancer stage 3 or 4
- Family distress impairing surrogate decision making
Oncology Indicators
- Metastatic or locally advanced cancer progressing despite systemic treatments with or without weight loss and functional decline;
- Poor Performance Status
- Brain metastases
- New spinal cord compression or neoplastic meningitis
- leukemia
Emergency Department Indicators
- Malignant hypercalcemia
- Progressive pleural/peritoneal or pericardial effusions
- Failure of first – or second-line chemotherapy
- Neoplastic pain and/or bone metastases
- Consideration of interventional pain management procedures
- Severe prolonged pancytopenia in the setting of an untreatable hematological problem (e.g., relapsed Multiple recent prior hospitalizations with same symptoms/problems
- Long-term-care patient with Do Not Resuscitate (DNR) and/or Comfort Care (CC) orders
- Patient previously enrolled in a home or residential hospice program
- Patient/caregiver/physician desires hospice but has not been referred
- Consideration of ICU admission and or mechanical ventilation in a patient
- with metastatic cancer and declining function
- with moderate to severe dementia
- with one or more chronic diseases and poor functional status at baseline