2 physicians need to certify. Terminal diagnosis.
Patient’s could sign in and they can sign out for any reason.
🔴 Patient must give consent (DPOA or family if patient is unable)
💧To bill for continuous care provide 8 hours a day care starting at 12 am
💧Patient can choose any physician to be his attending
💧Patient: consult another doc for secondary diagnosis (not for primary Dx : admitted with)
💧Respite care is for 5 days : should be use infrequently; Psychosocial crisis of the caregiver
💧Worsening s/s despite the treatment
💧Weight loss: > 10% in 6 months; 5% in 3 months ; despite food/fluid intake. Measuring weight or mid-arm circumference or abdominal girth or skin turgor or visualized, ill-fitting clothes or loose dentures or visual description of family members; decrease muscle mass.
💧Ascites : weigh the patient & abdominal girth.
💧Pain : not controlled or poorly controlled.
💧Patient / family / friends/ DPOA : all wants patient to be on hospice or comfort care.
💧Comfort care : last few days of life / towards the end of hospice.
💧General physical decline
💧PPS palliative performance scale = Karnofsky Scale < 70% (lower for HIV, stroke & coma)
💧FAST score for dementia worse than 7a or c & beyond
💧Decline in functional status: at least 2 or more ADL’s: (ABCDEF) Ambulation, Bathing, Continence, Dressing, Elevate (transfer), Feeding,
💧Decline in Descriptive scale : (MMNPE) Mental status; Mobility; Nutritional; Pain; Endurance.
💧Stage 3 or 4 pressure ulcers
💧Increase ER visits / multiple hospitalizations /physician office visits
💧 Declining enteral / parenteral support
💧 Multiple co-morbities: other diseases or s/s afflicting the patient
💧 Rapid disease progression
💧 Documenting life threatening complications / emphasizing positive & negative clinical findings
💧 Worsening clinical status
💧Dyspnea at rest, increased respiratory rate, using abdominal or accessory muscles, forced vital capacity <30%, needs O2 at rest, declining artificial ventilation.
💧Intractable : cough, nausea, vomiting, diarrhea poorly responsive to treatment
💧Fluid retention: peripheral, pleural, pericardial & lymphatic spaces
💧Systolic blood pressure < 90, or severe postural hypotension
💧Document all co-morbidities
💧Document clinical regression
💧Document declining in functional, emotional, social & ADLs
💧Changes in the level of consciousness
💧Worsening of other symptoms : document all
💧Dysphagia: leading to recurrent aspiration &/or inadequate oral intake shown as decrease food / fluid intake
💧Patient desire / will to die
💧Serum albumin < 2.5 gm/dl.