Question 1

AIDS

Accepted Answer

AIDS/HIV Hospice Eligibility Criteria.   Human immunodeficiency virus (HIV) is a disease which causes the body’s own immune system to attack itself. If left untreated, HIV can lead to acquired immunodeficiency syndrome (AIDS). AIDS is the most advanced stage of HIV. It currently has no cure.   HIV attacks a particular type of white blood cells called the T-helper cells or CD4 cells. CD4 cells are part of the body’s immune system, raising the alarm when the body needs to fight off an infection or illness. As HIV spreads through the body, more and more of the CD4 cells are destroyed, and the body becomes unable to fight off infections and disease.   When the number of CD4 cells falls below 200 cells/mmc3, the diagnosis is now considered to be AIDS, the final stage of HIV. An individual may also be considered to have AIDS if one or more opportunistic illnesses have developed.   While no specific number of symptoms is necessary to meet the hospice eligibility requirements for HIV/AIDS patients, here are a few of the criteria considered.    AIDS/HIV hospice criteria:    Must have established AIDS or HIV diagnosis Decision has been made to forego antiretroviral, antibacterial, antifungal, chemotherapeutic and prophylactic drug therapy related specifically to the AIDS diagnosis. Chronic, persistent diarrhea Significant weight loss of 10% or more in the past three months Generalized weakness Viral load > 100,000 copies/ml CD4 count

Question 2

Dementia

Accepted Answer

Hospice Criteria for Dementia.   More than 5 million Americans are currently living with Alzheimer’s disease and related dementias and more than 15 million family caregivers are providing unpaid support to their loved ones with Alzheimer’s or other dementia.   In the early stage of Alzheimer’s disease, individuals will experience memory lapses such as misplacing objects or having trouble coming up with the right word or name. They are still able to function independently, but will have increasing trouble with planning and organization.   As the individual reaches the moderate/middle stage, they will begin to require more care. It is during this time that the individual begins to experience more severe memory loss and confusion. They may be unable to remember names or be confused about where they are. Some individuals in this stage may need help remembering to dress appropriately for the weather. There will be changes in sleep patterns and personality. This stage typically lasts the longest – often for several years.   In end-stage dementia, individuals will require 24-hour assistance with daily living. They lose awareness of recent experiences and their surroundings and have increased difficulty communicating. Individuals with late-stage Alzheimer’s become vulnerable to infections, especially pneumonia. During end-stage dementia, it is important for caregivers to anticipate their loved one’s needs as they may even forget how to suck from a straw or how to swallow.   Due to the slow progression seen in individuals with Alzheimer’s disease and other dementias, families are often times unsure when their loved one becomes eligible for hospice by meeting established criteria for dementia. There is no specific number of symptoms a patient must exhibit to be eligible for hospice care. Please review list of commonly seen symptoms to determine if your loved one is exhibiting any of these symptoms and determine next steps.   Hospice eligibility criteria for dementia:    In order for a dementia patient to meet the hospice eligibility criteria, he or she must have a life expectancy of six months or less if the disease continues in its typical progression. For patients with dementia, it may be time to consider hospice when the patient’s physical condition begins to decline. Some key things to look for include: a diagnosis of other conditions as COPD, CHF, cancer or congenital heart disease an increase in hospitalizations, frequent visits to the doctor and/or trips to the ER a diagnosis or pneumonia or sepsis weight loss or dehydration due to challenges in eating/drinking speech limited to six words or less per day difficult swallowing or choking on liquids or food urinary and fecal incontinence Unable to sit upright without arm rests on chairs or may slip out of chairs and require sitting in special chairs unable to walk without assistance such as a walker or now requiring a wheelchair unable to sit up without assistance (will slump over if not supported) no longer able to smile Dementia symptom management.    Canon Hospice creates an individual interdisciplinary plan of care to meet the unique needs of each patient. For patients living with Alzheimer’s disease or other dementia, our team provides medical care to alleviate symptoms including pain and anxiety and personal care to assist caregivers in maintaining the patient’s dignity at end-of-life.   Medication related to the patient’s primary diagnosis and medical supplies such as incontinence products, hospital beds and wheelchairs are included in the hospice benefit, typically at no charge to the patient or family. These items will be delivered as needed to the patient, eliminating the need to run to the pharmacy or to research medical supply providers.   In addition, our team of emotional and spiritual support specialists provide education and support to family caregivers. This includes volunteers to sit with the patient so family members can take a break without worrying about the patient’s safety and assistance in arranging respite care. Our staff can also assist families with end-of-life planning, making funeral arrangements and bereavement support.   For the dementia patients that meet the hospice criteria and are already receiving care in a memory care unit or other long-term-care facility, Canon Hospice is available to partner with the facility to provide an extra layer of one-on-one care and attention. This includes providing complementary therapies and activities to supplement the clinical and personal care the patient receives such as reading or playing music for the patient, foot massages, or aromatherapy.   Our goal is to provide an enhanced quality of life for patients with end-stage Alzheimer’s disease or other dementias, making the most of lucid moments and ensuring the patient is comfortable and free of pain even when they are no longer able to communicate their needs.   For primary care physicians.   Canon Hospice is your partner in providing support to patients with late-stage Alzheimer’s disease or other dementias. We are available 24 hours a day, 7 days a week, 365 days a year to admit new patients. Our care team will work with you to facilitate an easy transition to hospice care for the patient and their family.   When to call hospice.   Due to the slow progression of Alzheimer’s disease and other dementia, it can be difficult for family members to determine when a patient becomes eligible for hospice care. Starting the hospice conversation early means you will have time to get all your questions answered and put a plan in place before a crisis occurs.   Canon Hospice is available to assess the patient in their home environment to determine whether they meet the criteria to begin hospice care. This assessment can take place in the home, a long-term-care facility, nursing home or hospital. We are happy to meet with families at the time and place most convenient for them to further discuss the hospice criteria for dementia.   To arrange a hospice consultation, fill out the form on this page or contact us.

Question 3

Cancer

Accepted Answer

Cancer Hospice Eligibility Criteria.   According to the American Cancer Society, Cancer is the second most common cause of death in the United States, accounting for nearly 1 out of every 5 deaths. There are over 100 different types of cancer, and each is classified by the type of cell initially affected.  These cells divide and begin to crowd out) normal, healthy cells. Cancer is commonly treated with surgery, chemotherapy, and radiation.   While treatment for cancer is often very successful, there may come a time when treatment is no longer effective or the patient may decide they no longer with to pursue curative treatment. At this point, the focus turns to comfort care and supporting the patient and their family through this transition.   Canon Hospice provides expert end-of-life care to ensure patients maintain the highest possible quality of life, surrounded by their family.   Hospice cancer criteria list.   As there are many different types of cancer, the following hospice cancer criteria are general rules used by physicians and caregivers in order to determine if hospice is the right choice for a patient.   Clinical hospice cancer criteria may include:   Metastatic cancer Decline in condition in spite of therapy Palliative Performance Score or Karnofsky score of 70% or less Electing to forgo further disease directed curative treatment (Palliative radiation may still be included.)  Certain cancer diagnoses are often eligible for hospice without other criteria including small cell lung cancer, pancreatic cancer, and primary CNS malignancy.   The indicators listed do not replace CMS regulations, local coverage determinations, or professional judgement. As the patient’s situation evolves, it is important to regularly look at their options. To schedule a hospice cancer assessment, please contact Canon Hospice.   Cancer symptom management.   If a cancer patient is eligible for hospice, the Canon Hospice team provides aggressive symptom management for a wide range of cancer-related issues. The interdisciplinary team of nurses, aides, social workers, chaplains, volunteers, and bereavement specialists work together with the patient and their family to address physical, emotional, and spiritual needs.   In addition, our team provides education to family caregivers on medication and medical equipment to ensure the patient receives the greatest benefit and increase the patient and family understanding of the diagnosis, treatment, and prognosis.   Once a patient begins hospice care, all medication related to the patient’s primary diagnosis and medical supplies and equipment such as oxygen, wheelchairs, and hospital beds will be provided at no cost by Canon Hospice. We will arrange for the delivery of medication and supplies, so the family does not have to make an extra trip to the pharmacy.   For primary care physicians.   Canon Hospice is your partner in ensuring your patient and their family receive the support they need when cancer treatment options are exhausted. If you believe your patient meets the cancer hospice eligibility criteria, we are available 24 hours a day, 7 days a week, 365 days a year to evaluate and as appropriate, admit new patients. Our pain and symptom management experts will work closely with you to facilitate an easy transition to hospice care, avoiding unnecessary hospital readmissions.   When to call hospice.   When cancer patients and their families shift the focus to comfort care, Canon Hospice is available to provide expert care and support the “whole patient" support in the location of the patient’s choice including their home, assisted living facilities and inpatient units.   Beginning the hospice conversation early allows you to have the time you need to explore all your options and have all your questions answered before a crisis occurs. Canon Hospice can meet with patients and their families at the location of your choice at any time, 24 hours a day, seven days a week, 365 days a year.   If you have questions about whether a patient meets the criteria to begin cancer hospice care, please contact us for a free hospice consultation.

Question 4

Cerebral Vascular Accident (CVA) / Stroke

Accepted Answer

Cerebral Vascular Accident Hospice Eligibility Criteria.   Stroke, or a cerebrovascular accident (CVA), is the leading cause of adult disability in the United States, and the fifth leading cause of death.   A stroke occurs when blood flow to an area of the brain is stopped. The oxygen-starved brain cells begin to die, causing an individual to lose the abilities controlled by that area of the brain such as memory or muscle control.   If the patient is not recovering after a CVA or stroke, hospice care may be necessary.    There are specific requirements that should be met before a physician recommends hospice care after a stroke of cerebrovascular accident.   Cerebral vascular accident/stroke hospice eligibility criteria: Palliative Performance Score or Karnofsky Score of 40% or less Mainly bed to chair bound Impaired functional status Requires assistance with activities of daily life (ADLs) Changes in orientation status Unable to maintain sufficient fluid and caloric intake Progressive weight loss   Symptom management - hospice care after stroke.   If you believe that you or a loved one is eligible for hospice after a stroke or cerebrovascular accident, Canon Hospice can help. The goal of hospice care after a stroke is to keep the patient comfortable. Nurses and aides, social workers, chaplains, volunteers, and bereavement counselors are available to support the patient and their family. This care can be provided in the location of patient’s choice including their home, an assisted living facility or an in-patient unit.   All medications related to their primary illness and medical equipment are provided. This can include medical equipment like hospital beds and wheelchairs as well as incontinence pads and bandages.   For primary care physicians.   Canon Hospice is your partner in ensuring your patients and their family receive the support they need after a stroke. If your cerebral vascular accident patient meets hospice criteria, we are available 24 hours a day, 7 days a week, 365 days a year to admit new patients. Our pain and symptom management experts will work closely with you to facilitate an easy transition to hospice care, avoiding unnecessary hospital re-admissions.   When to call hospice.   If a patient is experiencing some of the criteria listed above or if they have received a terminal diagnosis of six months or less to live after a stroke, please contact us at 228-575-6251 for a hospice consultation.

Question 5

Congestive Heart Failure (CHF) / Cardiopulmonary Disease

Accepted Answer

Congestive Heart Failure Hospice Eligibility Criteria.   Heart failure occurs when the heart muscles can no longer pump blood effectively and fluids can build up around the heart, abdomen, lungs and other parts of the body. This condition affects about 5 million people in the United States.   Patients with end-stage congestive heart failure (CHF) and terminal heart disease often make frequent doctor’s office, ER and hospital visits for breathing difficulties and fatigue. In fact, over one million people in the United States are admitted to inpatient settings for heart failure each year. One in four Medicare heart failure patients are readmitted to the hospital within 30 days at a cost of $17.4 Billion a year.   Many of these hospital visits could be prevented with the support of hospice care, but cardiac patients and families are often unaware of the hospice qualifications for CHF. And even more are unaware of the hospice qualifications and the added support available for CHF patients in their home or assisted living facility.   In addition to general hospice guidelines, we consider the following symptoms in cardiac patients when determining hospice eligibility criteria for CHF.   CHF and heart disease hospice criteria:  Identification of specific structural/functional impairments Ejection fraction

Question 6

COPD / Cardiopulmonary Disease

Accepted Answer

COPD Hospice Eligibility Criteria.   Chronic Obstructive Pulmonary Disease (COPD) is a term used to describe several progressive lung diseases including chronic bronchitis, emphysema, refractory (non-reversible) asthma, and some forms of bronchiectasis. COPD affects an estimated 30 million individuals in the United States   The slow decline of COPD often has patients unsure when they meet hospice eligibility for COPD. In addition the general hospice eligibility, we consider the following factors in hospice eligibility for COPD patients.   Hospice criteria for COPD: Recent visits to the ER or hospitalization for pulmonary infections or respiratory failure Dyspnea or tightness in the chest (FEV1

Question 7

Liver Disease

Accepted Answer

Liver Disease Hospice Eligibility Criteria.   Patients are considered to have end-stage liver disease when they meet the following hospice criteria. If your loved one meets the liver disease hospice eligibility requirements, you should consider scheduling a hospice consultation.   Liver disease hospice eligibility criteria: Weakness and compromised ability perform activities of daily living (ADLs) Recurrent variceal hemorrhage Hepatic encephalopathy Prothrombin time prolonged more than five seconds over control or INR > 1.5 Serum Albumin

Question 8

Neurological Conditions (non-Alzheimer’s dementia, Parkinson’s disease, Multiple Sclerosis, ALS, and Huntington’s disease)"

Accepted Answer

Neurological Hospice Eligibility Requirements.   Patients with an end-stage neurological condition including Non-Alzheimer’s dementia, Parkinson’s, MS, ALS, Huntington’s disease and other neurological conditions are eligible for hospice care. View the symptoms for end-stage neurological conditions below.   Hospice eligibility requirements for neurological conditions:  Structural/functional impairments Impaired mental function Impaired sensory function and pain Impaired neuromusculoskeletal and movement functions Impaired communication Impaired mobility Self-care deficit Activity limitations Comorbid and secondary conditions also contribute to a terminal prognosis.   Neurological Condition symptom management.   While each neurological condition has its own disease progression, Canon Hospice is trained to support individuals with neurological conditions by address their symptoms and unique needs.   Once a patient meets the neurological hospice eligibility criteria and begins treatment, all medications, medical supplies, and medical equipment are provided at no cost to the patient. This includes equipment and supplies like hospital beds, geriatric chairs, and positioning tools to help increase the patient’s comfort. Our team of experts will work to address pain management and any other symptoms the patient is experiencing.   In addition, our aides will work with family caregivers or facility staff to provide personal care to patients. The limited mobility of patients with advanced neurological conditions means special care must be taken to address skin breakdown, muscle atrophy, and any decubitus ulcers in addition to daily grooming needs.   Our emotional support team including social workers, chaplains and volunteers address emotional and spiritual needs. Social workers can also assist with end-of-life planning and connecting patients and their families to additional resources and support in their community.   For primary care physicians.    Canon Hospice is an extra layer of support for your patients and their families. We partner with primary care physicians to ensure the patient’s needs are being met in the location of their choice – whether that is their family home, an assisted living facility, or an inpatient unit.   As a neurological condition progresses and the patient meets the hospice eligibility criteria, they will need more and more support. Canon Hospice is able to provide whole-patient care with our multidisciplinary team of registered nurses, hospice aides, social workers, bereavement coordinators, chaplains and volunteers.   When to call hospice.   Canon Hospice partners with a patient’s primary physician to create an individualized plan to meet each patient’s unique needs. A team of nurses, aides, social workers, chaplains, volunteers, and bereavement counselors support both the patient and their families. Hospice care services for neurological condition patients can be provided in home, at an assisted living facility, or hospital as the patient prefers.   If a patient is experiencing some of the neurological hospice eligibility criteria listed above, please contact us at 228-575-6251 for a hospice consultation.

Question 9

Renal Disease

Accepted Answer

Renal Disease Hospice Eligibility Criteria   End-stage renal/kidney disease patients are eligible for hospice care. Read the list below to see the renal failure hospice criteria requirements.   Renal failure hospice criteria: Creatinine clearance of 8.0 mg/dl (>6.0 mg/dl for diabetics) Uremia with obtundation Nausea/Vomiting Patient has chosen not to have renal dialysis Intractable hyperkalemia Hepatorenal syndrome Structural and functional impairments Platelet count

Hospice

Eligibility

Hospice Eligibility Requirements:

Disease-specific hospice eligibility criteria

There are also specific hospice eligibility criteria to consider based on the patient’s primary diagnosis.