When is Your Patient Ready for Hospice Services?
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Patients are eligible for hospice care when a physician makes a clinical determination that life expectancy is six months or less if the terminal illness runs its normal course. To help make that determination, use these guidelines. These are provided as a convenient tool and are not meant to take the place of a physician's professional judgment.
If a patient does not meet these guidelines, they may still be eligible for hospice care due to co-morbidity or rapid decline.
General Criteria for a VITAS-Appropriate Patient
- The illness is terminal (a prognosis of ≤ 6 months) and the patient and/or family has elected palliative care.
- The patient has a declining functional status as determined by either:
- Palliative Performance Scale (PPS) rating of ≤ 50-60%
- Dependence in 3 of 6 Activities of Daily Living (ADLs)
- The patient has alteration in nutritional status, e.g., > 10% loss of body weight over last 4-6 months
- The patient has an observable and documented deterioration in overall clinical condition in the past
4-6 months, as manifested by at least one of the
- ≥ 3 hospitalizations or ED visits
- Decrease in tolerance to physical activity
- Decrease in cognitive ability
- Other comorbid conditions
90% of VITAS patients have a primary diagnosis of:
Other VITAS patients have diagnoses including:
All VITAS patients should:
- Have a prognosis of 6 months or less if the terminal illness runs its normal course
- Agree to a care plan with goals that are palliative in
nature—the goals of care are primarily focused on
management of the patient's physical,
psychosocial, emotional and spiritual symptoms,
rather than on treatment of the primary disease
Will a "palliative care plan" restrict what can be done for the patient?
VITAS provides aggressive treatment of all the patient’s symptoms, including pain and other physical symptoms, psychosocial, emotional and spiritual symptoms. All interventions focus on enhancing the patient's overall comfort and quality of life.
With the focus on symptom management rather than treatment of the primary disease, there is a limited role for many traditional disease-modifying therapies, such as:
- Radiation therapy
- Blood transfusions
- Total parenteral nutrition (TPN)
- Parenteral hydration
- Enteral feedings
When a VITAS patient receives one of these treatments, it is because the VITAS physician and interdisciplinary team, the attending physician and the patient and family all agree that:
- The primary goal of the therapy is to manage one
or more symptoms.
- The therapy has a high probability of being
effective in relieving the symptom(s).
- The benefits of the therapy outweigh any potential
side-effects of the treatment.
- The patient is expected to live long enough to
benefit from the treatment.
- The patient agrees to the intervention.
What are the most frequent symptoms that VITAS helps manage?
- Profound weakness
- Bowel obstruction
- Multi-system deterioration
VITAS provides these guidelines as a convenient tool. They do not take the place of a physician's professional judgment.