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Hospice of St. Lawrence Valley

Ensuring quality of life in any stage of illness

(315) 265-3105

6805 US Hwy 11 | PO Box 510 Potsdam, NY 13676

Hospice Criteria

 Cardiac Disease

Two main Categories are:

  • Congestive Heart Failure or
  • Cardiomyopathy Ischemic Heart Disease ASHD/CAD
  1. Dyspnea with minimal exertion & O2.
  2. Has been optimally treated with diuretics & vasodilators.
  3. Ejection fraction <20%.
  4. If CHF: Evidence of fluid overload in spite of medications.
  5. If CAD: History of angina, arrhythmias, previous MI.
  6. Angina syndrome present even at rest.
 End-Stage Pulmonary Disease
  1. Dyspnea at rest.
  2. Oxygen dependent.
  3. FEV less than 30% of predicted.
  4. Hypoxemia: pO2 ≤ 55 mmHg or O2 SAT ≤ 88%
  5. Hypercapnia: pCO ≥ 50 mmHg.
  6. Unintentioned wt. loss of >10% of body wt. over last 6 months
  7. Resting pulse >100/min
 End-Stage Liver Disease
  1. PT>5 sec over control or INR >1.5 and serum albumin <2.5 gm/dl
  2. Ascites, recurrent or refractory to tx.
  3. Hepatorenal syndrome (<BUN, <Cr, >urine)
  4. Hepatic Encephalopathy .
 Alzheimer’s & Related Disorders
  1. Ability to speak limited to six words.
  2. Lost ability to eat, walk and sit up without assistance.
  3. Markedly decreased nutritional intake.
  4. Urinary and fecal incontinence.
 Renal Failure
  1. No Dialysis.
  2. 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
  3. 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)
  1. Dyspnea O2 at rest & no artificial ventilation.
  2. Severe loss of ambulation & normal speech.
  3. Difficulty swallowing
  4. Loss of ADL’s
 Cerebrovascular Disease (Stroke)
  1.  Palliative Performance Scale value of <40%
  2. 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
  1. Frequent UTIs.
  2. Frequent respiratory infections.
  3. Multiple hospital admissions or ER visits.
  4. Unexplained weight loss >10%.
  5. Loss of appetite.
  6. Withdrawal from the environment.
  7. Unhealing decubiti.
  8. Unexplained or refractory temperatures.
  9. Hb<10, Alb <2.5
  10. Disabled and requires considerable assistance and medical care.
  11. 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.