Patient must have 1 and 2

  1. Stage VII or beyond according to FAST[1] with all of the following:
    1. Inability to ambulate without assistance
    2. Inability to dress without assistance
    3. Urinary and/or fecal incontinence (intermittent or constant)
    4. No consistent meaningful/reality based verbal communication; stereotypical phrases or the ability to speak is limited to a few intelligible words,


  1. Has had at least (1) of the following conditions within the past (12) months:
    1. Aspiration pneumonia
    2. Pyelonephritis or other upper urinary tract infection
    3. Septicemia
    4. Pressure ulcers, many and/or above stage 3
    5. Recurrent fever after antibiotics
    6. Inability to maintain sufficient fluid and calorie intake with either:
      1. 10% weight loss during the previous (6) months or
      2. serum albumin <2.5 gm/dl.

Hospice appropriate diagnoses (with supporting documentation):

  • Alzheimer’s disease (G30.9)
  • Cerebral lipidoses (E75.4)
  • Dementia with Lewy bodies (G31.83)
  • Dementia with Parkinsonism (G31.83)
  • Senile degeneration of the brain (G31.1)
  • Epilepsy (G40.A01-G40.A07)
  • Frontal dementia (G31.09)
  • Frontotemporal dementia (G31.09)
  • General paresis (syphilis) (A52.17)
  • Hepatolenticular degeneration (E83.00)
  • Huntington’s chorea (G10)
  • Jakob-Creutzfeldt disease
  • Multiple sclerosis
  • Pick’s disease of the brain (G31.01)
  • Polyarteritis nodosa (I75.029, I75.019)
  • Syphilis (A52.17)
In the absence of one or more of the above findings, rapid decline or comorbidities may also support eligibility for hospice care. 

[1] Refers to “Functional Assessment Scale,” see FAST Scale

Other guides:
CHF/Heart Disease
COPD/Pulmonary Disease
CVA /Stroke/Coma
Huntington’s Disease
Liver Disease
Neurological Diseases
      ALS (Amyotrophic Lateral Sclerosis)
      Muscular Dystrophy
      Myasthenia Gravis
      MS (Multiple Sclerosis)
Renal Failure, Chronic or Acute

Assessment Tools
Palliative Performance Scale (PPS)
New York Heart Association (NYHA) Functional Classes
Functional Assessment Staging (FAST) Scale

Frequent Co-Morbidity documentation requirements
Cachexia or Protein Calorie Malnutrition

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