- Cardiac Disease
-
Two main Categories are:
- Congestive Heart Failure or
- Cardiomyopathy Ischemic Heart Disease ASHD/CAD
- Dyspnea with minimal exertion & O2.
- Has been optimally treated with diuretics & vasodilators.
- Ejection fraction <20%.
- If CHF: Evidence of fluid overload in spite of medications.
- If CAD: History of angina, arrhythmias, previous MI.
- Angina syndrome present even at rest.
- End-Stage Pulmonary Disease
-
- Dyspnea at rest.
- Oxygen dependent.
- FEV less than 30% of predicted.
- Hypoxemia: pO2 ≤ 55 mmHg or O2 SAT ≤ 88%
- Hypercapnia: pCO ≥ 50 mmHg.
- Unintentioned wt. loss of >10% of body wt. over last 6 months
- Resting pulse >100/min
- End-Stage Liver Disease
-
- PT>5 sec over control or INR >1.5 and serum albumin <2.5 gm/dl
- Ascites, recurrent or refractory to tx.
- Hepatorenal syndrome (<BUN, <Cr, >urine)
- Hepatic Encephalopathy .
- Alzheimer’s & Related Disorders
-
- Ability to speak limited to six words.
- Lost ability to eat, walk and sit up without assistance.
- Markedly decreased nutritional intake.
- Urinary and fecal incontinence.
- Renal Failure
-
- No Dialysis.
- And either (acute):
- BUN>100, Creatinine >8.0mg/dl & Creatinine clearance <10cc/min.
- Serum creatinine >8.0mg/dl
- Estimated glomerular filtration rate (GFR) < 10ml/min
- And either (chronic)
- Creatinine clearance <10cc/min or <15cc/min with CHF comorbidity
- Serum creatinine >8.0 mg/dl
- Signs & symptoms of renal failure
- GFR <10 ml/min
- Lou Gehrig’s Disease (ALS)
-
- Dyspnea O2 at rest & no artificial ventilation.
- Severe loss of ambulation & normal speech.
- Difficulty swallowing
- Loss of ADL’s
- Cerebrovascular Disease (Stroke)
-
- Palliative Performance Scale value of <40%
- Inability to maintain hydration and caloric intake with one of the following:
- Weight loss of >10% in 6months or >7.5% in last 3 months
- Serum albumin of <2.5 gm/dl
- Current Hx of pulmonary aspiration not responsive to speech therapy
- Sequential calorie counts documenting inadequate caloric/fluid intake
- Dysphagia sever enough to prevent pt. from continuing fludis/food necessary to sustain life
- Cancer/Malignancy
-
1. Diagnosis confirmed through pathology or radiology.
2. Patient no longer receives curative treatment.
3. There is evidence of end-stage and/or metastatic disease. - Other Signs of Failure to Thrive and End of Life Disease
-
- Frequent UTIs.
- Frequent respiratory infections.
- Multiple hospital admissions or ER visits.
- Unexplained weight loss >10%.
- Loss of appetite.
- Withdrawal from the environment.
- Unhealing decubiti.
- Unexplained or refractory temperatures.
- Hb<10, Alb <2.5
- Disabled and requires considerable assistance and medical care.
- Symptoms of multiple organ failure.
* CMS no longer accepts Failure to Thrive or debility as a principal diagnosis beginning Oct. 1, 2014.
- Guidelines for Other End Stage Diagnoses
-
Please call Hospice to discuss criteria for other end-stage diagnoses at 315-265-3105.