All that follows is from Resource (1) below:
Decline In Clinical Status Guidelines
Patients will be considered to have a life expectancy of six
months or less if there is documented evidence of decline
in clinical status based on the guidelines listed below.
Since determination of decline presumes assessment
of the patient’s status over time, it is essential that both
baseline and follow-up determinations be reported
where appropriate. Baseline data may be established on
admission to hospice or by using existing information
from records. Other clinical variables not on this list may
support a six-month or less life expectancy. These should
be documented in the clinical record.
These changes in clinical variables apply to patients
whose decline is not considered to be reversible. They
are examples of findings that generally connote a poor
prognosis. However, some are clearly more predictive of a
poor prognosis than others; significant ongoing weight loss
is a strong predictor, while decreased functional status is
A. Progression of disease as documented by worsening
clinical status, symptoms, signs and laboratory results.
a. Recurrent or intractable serious infections such as
pneumonia, sepsis or pyelonephritis;
b. Progressive inanition as documented by:
1. Weight loss of at least 10% body weight in the
prior six months, not due to reversible causes such as
depression or use of diuretics;
2. Decreasing anthropomorphic measurements (midarm
circumference, abdominal girth), not due to
reversible causes such as depression or use of diuretics;
3. Observation of ill-fitting clothes, decrease in skin
turgor, increasing skin folds or other observation of
weight loss in a patient without documented weight;
4. Decreasing serum albumin or cholesterol.
5. Dysphagia leading to recurrent aspiration and/or
inadequate oral intake documented by decreasing
food portion consumption.
c. Dyspnea with increasing respiratory rate;
d. Cough, intractable;
e. Nausea/vomiting poorly responsive to treatment; f. Diarrhea, intractable;
g. Pain requiring increasing doses of major analgesics
more than briefly
h. Decline in systolic blood pressure to below 90 or
progressive postural hypotension;
j. Venous, arterial or lymphatic obstruction due to local
progression or metastatic disease;
l. Pleural/pericardial effusion;
n. Change in level of consciousness.
Laboratory (When available. Lab testing is not
required to establish hospice eligibility.):
o. Increasing pCO2 or decreasing pO2 or decreasing SaO2;
p. Increasing calcium, creatinine or liver function studies;
q. Increasing tumor markers (e.g. CEA, PSA);
r. Progressively decreasing or increasing serum sodium or
increasing serum potassium.
B. Decline in Karnofsky Performance Status (KPS ) or
Palliative Performance Score (PPS) due to progression
C. Progressive decline in Functional Assessment Staging (FAST) for dementia (from 7A on the FAST).
D. Progression to dependence on assistance with additional activities of daily living (see Part II, Section 2).
F. History of increasing ER visits, hospitalizations, or
physician visits related to the hospice primary diagnosis prior to election of the hospice benefit.
1. Determining Hospice Eligibility In Terminally Ill Patients Hospice by The Bay – An Affiliate Of USCF Health, Updated 3-2014