Resources for Physicians: When to refer your patient to hospice

1) The patient or DPOA understands that they have a terminal disease
 a.They forego aggressive, curative therapy in favor of comfort care.
 b. They desire hospice services.

2) The attending physician and the hospice medical director must both agree that the patient has six months or less to live. As this is a subjective criterion, certain guidelines have been put in place that imply a six month prognosis. A patient does not have to die in six months to be eligible for hospice; they simply need to meet the medical criteria. If your patient meets the following criteria they probably are eligible for hospice.

a. General
 i. Weight loss of >10% over the last 6 months
 ii. Serum Albumin < 2.5
 iii. Repeated hospital visits over the last few months

b. Cancer
 i. Confirmed cancer diagnosis
 ii. Patients have exhausted or refused all surgical, radiological, and chemotherapeutic options for their disease

c. Heart Disease
 i. New York Heart Association Class IV disease: chest pain or SOB at rest or with any movement
 ii. Patient is currently on the maximal dose of medications

d. Lung Disease
 i. SOB at rest, FEV <30% after bronchodilator, pO2 < 55

e. Liver Disease
 i. INR > 1.5 (without anticoagulants) and Serum albumin < 2.5 gm/dL
ii. At least one of the following: jaundice, ascites, encephalopathy, bleeding varices, hepatorenal syndrome

f. Renal Disease
i. Dialysis dependence and not seeking or eligible for dialysis

g. Dementia/Stroke
 i. Unable to walk and unable speak more than 6 different words/day
 ii. Progressive weight loss/ poor intake

h. Neuromuscular Disease
 i. Impaired swallowing or impaired breathing due to disease or unusually rapid progression of the disease

If you have any questions or concerns on these guidelines, please do not hesitate to contact Angela Hospice Medical Director, Dr. James Boal, at (866) 464-7810.


Compassionate care for children, adults, and families since 1985

Angela Hospice is a Felician-sponsored ministry

Angela Hospice Home Care
14100 Newburgh Road
Livonia, Michigan 48154-5010
TEL: 734.464.7810
Toll Free: 866.464.7810