Hospice: admitting / discharging

Anybody could refer the patient to hospice. TERMINAL DX.

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

💧Recurrent infections

💧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. 

💧Severe edema 

💧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

💧Increased weakness

💧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. 

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