Eligibility by General Decline

Assessing General Decline in Patients with Terminal Diagnoses

(used to support any terminal diagnosis)

Patient’s decline in clinical status is evidenced by (include as many as possible- they are listed in order of predictive power)

1. Clinical Status
   1. Recurrent/intractable serious infections such as pneumonia, sepsis, or pyelonephritis
   2. Progressive inanition (loss of vitality or vigor) as shown by:
      1. >10% weight loss in last 6 months, not due to reversible causes such as depression or diuretics
      2. Decreasing anthropomorphic measurements (mid-arm circumference, abdominal girth)
      3. Observation of ill-fitting clothes, poor skin turgor, increased skin folds, etc.
      4. Decreasing albumin or cholesterol levels
      5. Dysphagia leading to recurrent aspiration, and/or poor oral intake
2. Intractable Symptoms
   1. Dyspnea with increased respiratory rate
   2. Intractable cough
   3. Nausea/vomiting, poorly responsive to treatment
   4. Intractable diarrhea
   5. Pain requiring increasing does of major analgesics more than briefly

3. Clinical Signs
   1. Decline in systolic BP to below 90 or progressive postural hypotension
   2. Ascites
   3. Circulatory obstruction from progression of disease, (arterial, venous, lymphatic from local or metastatic disease)
   4. Edema
   5. Pleural/pericardial effusion
   6. Weakness
   7. Persistent change in level of consciousness
4. Labs (when available)
   1. Increasing pCO2, decr pO2/pulse oximeter
   2. Increasing calcium, creatinine, or liver function tests
   3. Increased cancer amrkers (CEA, PSA etc)
   4. Progressively increasing or decreasing serum sodium, increasing serum potassium
5. Other
   1. Decline in KPS or PPS due to progression of disease
   2. Progressive decline in FAST score (for stable, severe dementia from FAST 7A t lower level)
   3. Progressive dependence on assistance with ADLs
   4. Progressive stage 3-4 ulcers despite optimal care
   5. History of increasing ER visits and/or hospitalizations, doctor visits related to hospice primary diagnosis prior to hospice admission
   6. KPS/PPS <70%
   7. Needs assistance in 2 or more ADLs:
      1. Ambulation
      2. Continence
      3. Transfer
      4. Dressing
      5. Feeding
      6. Bathing