Healthcare Professionals

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PPS Terms Defined

Some terms on the PPS have similar meanings, but differences in meaning will become easier to identify as you move through the chart. The goal is to find an overall best fit using all five columns on the chart. Here is an explanation of each term to help you get started.

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Hospice Eligibility Guidelines

Click here for a printable Hospice Eligibility Guidelines sheet.

When is an ALS patient eligible for hospice care?

Patients are considered to be hospice-eligible for amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) if they meet the following guidelines: 

  • BOTH rapid progression of ALS and critically impaired ventilatory capacity or 
  • BOTH rapid progression of ALS and critical nutritional impairment with a decision not to receive artificial feeding or 
  • BOTH rapid progression of ALS and life-threatening complications such as:
    • Recurrent aspiration pneumonia 
    • Decubitus ulcers, multiple, stage 3-4, particularly if infected 
    • Upper urinary tract infection, e.g., pyelonephritis 
    • Sepsis 
    • Fever recurrent after antibiotics 

KAREN ANN QUINLAN HOSPICE provides these guidelines as a convenient tool. They do not take the place of a physician’s professional judgment. 

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When is your dementia patient ready for hospice care?

Alzheimer’s disease and other progressive dementias are life-altering and eventually fatal conditions for which curative therapy is not available. Patients with dementia or Alzheimer’s are eligible for hospice care when they show all of the following characteristics:1

  • Unable to ambulate without assistance 
  • Unable to dress without assistance 
  • Unable to bathe properly 
  • Incontinence of bowel and bladder 
  • Unable to speak or communicate meaningfully (ability to speak is limited to approximately a half dozen or fewer intelligible and different words) 

Thinking of dementia as a terminal illness from which patients will decline over a matter of years, rather than months, allows healthcare professionals to focus explicitly and aggressively on a palliative care plan.

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Types of Chronic Lung Disease That May Warrant Hospice Care

Hospice care focuses on making the most of life, however long that may be, by prioritizing patient comfort and addressing symptoms, including shortness of breath and pain. When curative or restorative treatments are no longer effective, these chronic lung diseases may require hospice care:

  • Chronic obstructive pulmonary disorder (COPD)
  • Emphysema
  • Chronic bronchitis
  • Chronic asthma
  • Bronchiectasis
  • Pulmonary fibrosis
  • Cystic fibrosis
  • End-stage tuberculosis
place of a physician’s professional judgment. 
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End-stage disease classifications of patients who are hospice-appropriate
Characteristics of end-stage congestive heart disease
  • New York Heart Association (NYHA) Class III if any of the following symptoms are present during less-than-normal activity (i.e. patient is comfortable only at rest):
    • Fatigue
    • Palpitations
    • Angina or dyspnea with exercise
  • NYHA Class IV as manifested by any of the following symptoms:
    • Dyspnea and/or other symptoms at rest or with minimal exertion
    • Inability to carry out physical activity without dyspnea and/or other symptoms
    • If physical activity is undertaken, dyspnea and/or other symptoms worsen
  • The patient is being optimally treated for congestive heart failure with diuretics and vasodilators, such as ACE inhibitors, or they are maximally medically managed and have no available surgical options.
Comorbid heart disease risk factors
  • Hypertension
  • Diabetes
  • Coronary heart disease
  • Family history of cardiomyopathy
  • Prior myocardial infarction
  • Valvular heart disease
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What are the hospice eligibility guidelines for patients with end-stage HIV/AIDS?

Patients are considered in the terminal stage of their illness (life expectancy of six months or less) if they meet the following (1 and 2 must be present; factors from 3 will add supporting documentation):

1. CD4+ count <25 cells/mm3 or persistent viral load >100,000 copies/ml, plus one of the following:
  • CNS lymphoma
  • Untreated or not responsive to treatment; wasting (loss of 33% lean body mass)
  • Mycobacterium avium complex (MAC) bacteremia, untreated, unresponsive to treatment or treatment refused
  • Progressive multifocal leukoencephalopathy
  • Systemic lymphoma with advanced HIV disease and partial response to chemotherapy
  • Visceral Kaposi’s sarcoma unresponsive to therapy
  • Renal failure in the absence of dialysis
  • Cryptosporidium infection
  • Toxoplasmosis unresponsive to therapy
  • Cytomegalovirus (CMV) infection
2. Decreased performance status of <50 as measured by the Karnofsky Performance Status (KPS) scale
3. Documentation of the following factors will support eligibility for hospice care:
  • Chronic persistent diarrhea for one year
  • Persistent serum albumin <2.5
  • Concomitant, active substance abuse
  • Age >50 years
  • Absence of antiretroviral, chemotherapeutic and prophylactic drug therapy related specifically to HIV disease
  • Advanced AIDS dementia complex
  • Toxoplasmosis
  • Congestive heart failure, symptomatic at rest

Some patients who do not meet the above guidelines may still be appropriate for hospice care because of other comorbidities or rapid decline. Coverage for these patients may be approved on an individual consideration basis.

The cause of death of HIV-infected patients in the HAART era is increasingly likely to be a chronic medical condition such as hepatic failure or malignancies, with traditional opportunistic infections (OIs) declining in importance.

In late-stage HIV-infected patients in an HIV palliative care program, the following three characteristics were more predictive of mortality than traditional HIV prognosis variables:

  • Decreased performance status as measured by the Karnovsky Performance Status scale
  • Impairments in activities of daily living (ADLs)
  • Age >65
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When Is Your Cancer Patient Eligible for Hospice Care?

In oncology, the biggest predictor of hospice eligibility is the patient’s functional status, which is determined by the Eastern Cooperative Oncology Group (ECOG) scale or the Palliative Performance Scale (PPS). 

Because specific prognosis varies from patient to patient, we suggest using these factors as general guidance.

ECOG Score for Functional Status

Using the ECOG scale, a median survival of three months roughly correlates with a score of >3. An ECOG score of 2 is generally supportive of being eligible for hospice services.

0: Asymptomatic
1: Symptomatic but completely ambulatory
2: Symptomatic, <50% in bed during the day
3: Symptomatic, >50% in bed but not bedbound
4: Bedbound
5: Death

Ask the Patient About Functional Status

The simplest method to assess functional ability is to ask patients: How do you spend your time? How much time do you spend in a chair or lying down?

If >50% of a patient’s time is spent sitting or lying down, and if that time is increasing, you can roughly estimate the prognosis at three months or less. Survival time tends to decrease further as additional physical symptoms develop—especially dyspnea, if secondary to the cancer.

Palliative Performance Scale for Functional Status

Typically, a cancer patient who scores 70% or lower on the Palliative Performance Scale may be eligible for hospice. 

Typically, these patients:

  • Are unable to carry on normal activity or do normal work
  • Are unable to move or ambulate; spend more than 50% of their time in a bed, chair or a single room
  • Exhibit evidence of significant disease
  • Are able to provide only limited self-care
  • Have reduced nutritional intake 
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Click Here for Printable Chart

Click here for printable Hospice Eligibility Guidelines Sheet