hospice guidelines for determining prognosis

^[1]^[2]^[3]^[4]

Introduction

General guidelines: (see more specific guidelines)

a hospice consultation is premature without first discussing this with the patient

prognosis of 6 months or less as determined by 2 physicians
- specific diagnosis
- combination of factors
- no specific diagnosis necessary
patient & or family must have elected treatment goals directed relief of symptoms, rather than cure of underlying disease
- a "do not resuscitate" status is not required
clinical progression of disease
- multiple Emergency department visits or inpatient hospitalizations
- Karnofsky performance index < 50
- dependence in at least 3/6 basic activities of daily living (bADL)
- progression past stage 7 of functional assessment scale
  - functional assessment tool (FAST) score of 7c or worse^[1]
recent impaired nutritional status
- unintentional & progressive weight loss of > 10 lbs
- serum albumin < 2.5 mg/dL
  - not a requirement for Parkinson's disease
frailty itself is not a hospice qualifying diagnosis^[2]