Determining Eligibility for Hospice Care

Transcription

1 Determining Eligibility for Hospice Care Main Number: Toll Free Number:

2 Many people may not understand all that Regional Hospice can offer or they are not aware of the many diagnoses that can qualify a patient for hospice services. If you have a patient with a life-limiting illness that meets the prognosis and eligibility requirements, they may be eligible for hospice or palliative homecare services from Regional Hospice.

3 Eligibility Criteria for Hospice Benefit: Hospice care is a shift from curative treatment to comfort care and relief of symptoms. A physician must certify the eligible prognosis (see guidelines). Eligible patients have: A terminal prognosis of 6 months or less, if the illness runs its normal course and the patient and/or family have been informed of this determination A diagnosis that qualifies for hospice care (see guidelines) Goals of care, as determined by the patient and/or family, that are directed toward relief of symptoms rather than curing the underlying disease Services Provided Regional Hospice offers patients and families skilled nursing care, spiritual and emotional support, volunteer services. As part of our comprehensive continuum of care, at no cost to the patient or family, we provide: All medications and supplies related to the terminal illness Durable medical equipment (hospital bed, walker, oxygen, concentrator, bedside commode, or other equipment) Coordination of care by an expert team of nurses, hospice aides, social workers, spiritual caregivers, and volunteers with scheduled visits Dietary counseling and physical, occupational, speech, and respiratory therapy services as appropriate 24 hrs/7 days a week access to phone triage and, as necessary, urgent clinical staff visits Services wherever a patient resides, either in a private home, skilled nursing facility or assisted living residence Short-term continuous nursing care for crisis care of acute symptoms that can be managed at home with extra support from our specialized team. Five-day inpatient respite periods when caregivers require a break from caregiving responsibilities Bereavement support and counseling services Regional Hospice, an affiliate of Danbury Hospital, is a state and Medicare certified home healthcare and hospice agency.

4 Medical Criteria for Determining Eligible Prognosis Patients who meet the requirements below may be eligible for hospice care. Cancer Evidence of end-stage disease and/or metastasis confirmed by pathology, radiology or diagnostic tests. Lab/diagnostic studies support disease progression. A continued decline in spite of therapy Patient declines further disease directed therapy (Certain cancers with poor prognosis, such as small cell lung cancer, brain or pancreatic cancer, may be hospice eligible without fulfilling the other criteria) Pulmonary Disease Disabling dyspnea at rest, with poor response to bronchodilators resulting in decreased functional capacity Progressive pulmonary disease, e.g., increasing ER visits or hospitalizations for pulmonary infections and/or respiratory failure, and Hypoxemia at rest on room air - po2 55 mm Hg on room air - O2 sat 88% on supplemental O2 - Hypercapnia: pco2 50mm Hg. Presence of cor pulmonale or right heart failure due to lung disease evidenced by EKG or chest x-ray Unintentional progressive weight loss > than 10% of body weight over preceding 6 months Resting tachycardia > 100/min Liver Disease End-stage cirrhosis: not a candidate for liver transplant. PT > 5 sec over control or INR >1.5 AND serum albumin < 2.5 gm/dl. At least one of the following: - ascites despite treatment - spontaneous peritonitis - hepatorenal syndrome - hepatic encephalopathy despite treatment - recurrent variceal bleed. The following factors all support eligibility for hospice - Progressive malnutrition - Muscle wasting with reduced strength and endurance - Continued active alcoholism - Hepatocellular carcinoma - Hepatitis B positivity - Hepatitis C refractory to interferon treatment

5 Dementia Severity of dementia FAST Stage 7 or beyond: - unable to walk, dress, or bathe without assistance - cannot sit up without assistance - urinary and fecal incontinence - ability to speak limited to 6 or fewer intelligible words - loss of ability to smile - loss of ability to hold up head independently Comorbid condition within the past 12 months: - aspiration pneumonia - pyelonephritis - septicemia - multiple stage 3-4 decubiti - fever after antibiotics - unable to maintain fluid/caloric intake with 10% weight loss in previous 6 months or serum albumin < 2.5 gm/dl Heart Symptoms of congestive heart failure at rest Discomfort with any activity (NYHA Class IV) Patient already optimally treated with diuretics and vasodilators, e.g., ACE inhibitors. The following factors will support eligibility but are not required: - Treatment resistant symptomatic supraventricular or ventricular arrhythmias - History of cardiac arrest or resuscitation - History of unexplained syncope - Brain embolism of cardiac origin - Concomitant HIV disease ALS Rapid progression of ALS within 12 months Critically impaired breathing capacity - Vital capacity < 30% or normal - Significant dyspnea at rest - Supplement O2 required at rest - Patient declines artificial ventilation Nutrition is impaired with evidence of weight loss and dehydration in absence of artificial feeding methods Patient declines artificial feedings Life-threatening complications within last 12 months - Recurrent aspiration pneumonia - Urinary tract infection - Sepsis - Fever after antibiotics - Multiple stage 3-4 decubitus ulcers

6 Stroke Acute Phase - Coma or persistent vegetative state beyond three days duration - Post-anoxic stroke, coma or severe obtundation, accompanied by severe myoclonus, beyond three days duration - Dysphagia severe enough to prevent feeding or hydration Chronic Phase - Post stroke dementia FAST stage 7 or beyond - Karnofsky score of 40% or less - Unintentional weight loss of >10% over prior six months OR serum albumin < 2.5 gm/dl Coma any 3 of the following: - Abnormal brain stem response - Absent verbal response - Absent withdrawal response to pain - Serum creatinine > 1.5 mg/dl Renal Disease Patient is not seeking dialysis or renal transplant Creatinine clearance < 10 cc/min (<15 cc/min for diabetics) Serum creatinine >8.0 mg/dl (>6.0 mg/dl for diabetics) Estimated glomerular filtration rate (GFR) < 10 ml/min. Comorbid conditions: - Malignancy of other organ system - Chronic lung disease - Advanced cardiac disease - Advanced liver disease - AIDS - Albumin< 3.5 gm/dl - Platelet count < 25,000 - Disseminated intravascular coagulation - GI bleeding Other Factors Karnofsky 50 for non-cancer (requires considerable assistance and frequent medical care), 70 for malignancies. Dependent on > 2 ADL activities (bathing; dressing; feeding; transfers; continence; ambulation to bathroom). Involuntary weight loss > 10% of BW in past 6 months. Recurrent aspiration Serum albumin < 2.5 gm/dl.

7 Decline in Clinical Status Recurrent or intractable serious infections such as pneumonia, sepsis or pyelonephritis Progressive inanition as documented by: - weight loss of at least 10% body weight in the prior 6 months, not due to reversible causes such as depression or use of diuretics - decreasing anthropomorphic measurements (mid-arm circumference, abdominal girth), not due to reversible causes such as depression or use of diuretics - observation of ill-fitting clothes, decrease in skin turgor, increasing skin folds or other observation of weight loss in a patient without documented weight - decreasing serum albumin or cholesterol - dysphagia leading to recurrent aspiration and/or inadequate oral intake documented by decreasing food portion consumption Symptoms including: - Dyspnea with increasing respiratory rate - Intractable cough - Nausea/vomiting that is not responsive to treatment - Intractable diarrhea - Pain requiring increasing doses of major analgesics more than briefly Signs including: - Decline in systolic blood pressure to below 90 or progressive postural hypotension - Ascites - Venous, arterial or lymphatic obstruction due to local progression or metastatic disease - Edema - Pleural/pericardial effusion - Weakness - Change in level of consciousness To make a referral, please contact: Regional Hospice 405 Main Street Danbury, CT (203)

8 Karnofsky Scoring The Karnofsky score runs from 100 to 0, where 100 is perfect health and 0 is death. Although the score has been described with intervals of 10, a practitioner may choose decimals if he or she feels a patient s situation holds somewhere between two marks normal, no complaints, no signs of disease 90 - capable of normal activity, few symptoms or signs of disease 80 - normal activity with some difficulty, some symptoms or signs 70 - caring for self, not capable of normal activity or work 60 - requiring some help, can take care of most personal requirements 50 - requires help often, requires frequent medical care 40 - disabled, requires special care and help 30 - severely disabled, hospital admission indicated but no risk of death 20 - very ill, urgently requiring admission, requires supportive measures or treatment 10 - moribund, rapidly progressive fatal disease processes 0 - death FAST Scale The Functional Assessment Staging (FAST) scale is used to chart the decline of people with Alzheimer s disease or dementia. Stage Characteristics 1: normal Adult no functional decline 2: normal older adult Personal awareness of some functional decline 3: early dementia Noticeable deficits in demanding job situations 4: mild dementia Requires assistance in complicated tasks such as handling finances, planning parties, etc. 5: moderate dementia Requires assistance in choosing proper attire 6: moderately severe Requires assistance dressing, bathing, dementia and toileting. Experiences urinary and fecal incontinence 7: severe dementia Speech ability declines to about a half-dozen intelligible words. Progressive loss of abilities to walk, sit up, smile and hold head up.