Is Your Patient Appropriate For A Referral?

For Clinicians

Is your patient appropriate for hospice referral?

Hospice care is based strictly on need, and the opinion of any physician on terminal prognosis WITHOUT treatment if the disease runs its natural course. Hospice involvement in your patient’s care will allow you to get additional support for your patient in helping managing complex pain, difficult to control symptoms, comorbidities. Hospice also assists with improving patient and family communication and coordination of care. They can help you save time by helping manage the patient while providing additional support to your sickest and most critical patients.

The goal of hospice remains to provide compassionate care to our seriously ill patients to improve quality of life. The additional services provided by hospice (equipment, supplies, nursing visits, CNA visits, chaplain visits, social worker visits, detailed care plan and medication management in conjunction with the the primary care team) focuses on improving quality of life. However, this increased attention to detail also results in patients living longer because of the additional support they are receiving.

The Following Criteria May Indicate Need For A Hospice Referral:

Progressive Serious or Chronic Illness

  • Declining ability to complete activities of daily living
  • Weight loss (especially if occurring despite medical intervention)
  • Multiple hospitalizations
  • Difficult to control physical and emotional symptoms related to medical illness
  • Patient, family or physician uncertainty regarding prognosis or goals of care
  • Requests for futile care
  • DNR order conflicts
  • Use of TPN or tube feedings in cognitively impaired and seriously ill patients
  • Patient or family requesting information regarding hospice or palliative care
  • Limited social support with a serious illness
  • Increasing patient and family spiritual or psychological distress due to progressive illness

We will help with difficult conversations to make sure your patient and family get the best care available to them. We specialize in these difficult conversations. If for any reason your patient is not hospice eligible, we can help make referrals to palliative care programs or other services they may be eligible for.

Oncology Criteria

  • Metastatic or locally advanced disease that is progressing despite systemic treatments
  • Continued weight loss
  • Karnofsky and/or Palliative Performance Score of <50%
  • ECOG of > 3
  • Progressive brain metastasis following radiation
  • New spinal cord compression or neoplastic meningitis
  • Malignant hypercalcemia
  • Progressive pleural/peritoneal or pericardial effusions
  • Failure of second line chemotherapy
  • Multiple painful bony metastasis that are difficult to control
  • Severe or prolonged pancytopenia in context of an Untreatable hematological problem (ie a relapsed leukemia)
  • Weight loss (especially if occurring despite medical intervention)
  • Multiple hospitalizations

Intensive Care Unit and Emergency Room Criteria

  • Recurrent ER admissions with same problem
  • Long term care patient with DNR/Comfort Care Order who presents to ER
  • Patients with severe dementia brought to ER
  • Patients with inability to perform activities of daily living.
  • ICU admission for patient with significant underlying dementia
  • Two or more ICU admissions during same hospitalization
  • Prolong or difficult ventilator withdrawal
  • Multiorgan failure especially with evidence of injury and development of new chronic illnesses
  • Metastatic cancer
  • Anoxic brain injury
  • Consideration of patient being transferred to a long term ventilator facility should involve minimum of palliative care discussion with family if not hospice discussion
  • Physician and staff concern for futile care
  • Presence of numerous wound especially stage IV sacral wounds in presence of underlying dementia resulting in ICU admission

Hospice remains a difficult topic of discussion, yet it remains necessary for many of our patients. At Lenity Light Hospice, we are here to help patients during this difficult time. We do this by openly and honestly discussing clinical information and have frank goals of care discussions to allow patients and families make critical decisions that can help guide patient care.

Additional Clinical Resources: – Center to Advance Palliative Care. Offers resources for curative palliative care for palliative and non-palliative care experts

American Academy of Hospice and Palliative Medicine – AAHPM is the professional organization for physicians specializing in hospice and palliative medicine, nurses, and other healthcare providers

Texas and New Mexico Hospice Organization – State wide organization for hospice information and education. – Patient specific site to help patients deal with difficult decisions. This site is a good resource to present to patients and families who are needing additional information on how to navigate their serious illness.

Hospice Action Network – Advocating for the hospice and palliative care community

NHPCO – National Hospice and Palliative Care Organization – NHPCO provides its members with the essential tools they need to stay current with leading practices, understand policy changes, and improve their quality of care.

National Hospice Foundation – The work of the National Hospice Foundation is to establish a world where everyone facing serious illness, death, and grief will experience the best that humankind can offer. – For the National Quality Forum (NQF), National Framework and Preferred Practices for Palliative and Hospice Care Quality

Texas Health and Human Servcies – Texas state site for hospice information

Hospice Foundation of America – Hospice Foundation of America educates the public and health care professionals about death, dying and grief.

NAHC – The National Association for Home Care & Hospice (NAHC) is the largest and most respected professional association representing the interests of chronically ill, disabled, and dying Americans of all ages and the caregivers who provide them with in-home health and hospice services