Must have 1 and 2.

  1. Poor functional status with PPS[1] ≤40%


  2. Poor nutritional status with an inability to maintain sufficient fluid and calorie intake with either:
    1. >10% weight loss over the previous (6) months
    2. >7.5% weight loss over the previous (3) months
    3. Serum albumin <2.5 gm/dl
    4. Current history of pulmonary aspiration without effective response to speech language pathology interventions to improve dysphagia and decrease aspiration events

Supporting evidence:

  • Coma (any etiology) with (3) of the following on the third day of coma:
    • Abnormal brain stem response
    • Absent verbal responses
    • Absent withdrawal response to pain
    • Serum creatinine >1.5gm/dl

[1] Refers to Palliative Performance Scale

In the absence of one or more of the above findings, rapid decline or comorbidities may also support eligibility for hospice care. 

Other guides:
CHF/Heart Disease
COPD/Pulmonary Disease
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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