Assessing your Level of Care.

Determining the need for hospice or palliative care is a compassionate step toward ensuring comfort, dignity, and quality of life for individuals facing serious illness. Whether for yourself or a loved one, understanding the level of care required begins with evaluating physical, emotional, and spiritual needs. This assessment helps identify symptoms requiring management, such as pain or difficulty breathing, while also considering emotional support, family dynamics, and end-of-life planning. Below, we have included some important questions to ask when talking with your hospice or palliative care provider, as well as informative scales to help you assess the current level of your loved one’s health. These tools are designed to guide thoughtful conversations and provide clarity about the care options best suited to your situation.

Important Questions to Ask your Hospice Provider

Click on question for answers.

Commonly Used Abbreviations in Eligibility Guide

ADL's:	Activities of Daily Living
POC:	Plan of Care
PPS:	Palliative Performance Scale
FAST:	Functional Assessment Staging of Alzheimer’s Disease Scale
ECOG:	Easter Cooperative Oncology Group Performance Status

General Hospice Admission Indicators

Admission criteria includes:

Life-limiting illness with a prognosis of ≤ 6 months
Patient and family desire palliative care
Two physicians confirm terminal condition – Attending physician and UpliftedCare Medical Director

Admission indicators may include:

Recent decline in functional status as determined by:
- Palliative Performance Scale (PPS) ≤ 50%
- Increasing dependence in ADLs
Impaired nutritional status evidenced by either:
- Weight loss
- Decreased intake or downgrade in diet
Recent hospitalizations or emergency room visits
Infections such as UTI and upper respiratory tract infection
Sepsis

Decubitus ulcers

4 Levels of Hospice Care

Routine Home Care – Provides care in the home or nursing home setting. Hospice staff makes intermittent visits with the back-up of an on-call system for staff support at all hours.
Continuous Care – This service may be necessary if a crisis develops. Care is still provided in the patient’s home, with hospice staff staying in place to manage symptoms that are creating the crisis or to provide other more technical care than is considered routine care. Once symptoms are controlled, the routine level of home care is restored.
Respite Care – Provided when family members acting as the patient’s primary caregiver need a break. Here, the hospice team makes arrangements to have the patient transferred to a Medicare-approved facility for up to five days at a time while the family gets some much needed rest.
General Inpatient Care – This service may be required for patients with more complex care needs. In this scenario, the patient is transferred to a hospital for more intensive medical or nursing care. Reasons for general inpatient care include uncontrolled pain, unrelenting nausea and vomiting, severe shortness of breath, seizures, or other problems which cannot be managed in the home. Once the acute issues are managed, the routine level of home care is restored.

Hospice Indicators for Cardiac Disease may include:

NY Heart Association Class IV symptoms of CHF (present at rest)
Optimally treated with diuretics and vasodilators (ACE inhibitors)
Ejection Fraction of 20% or less with left ventricular systolic dysfunction
Frequent physician visits for symptom management and minimal response to treatment
Multiple hospitalizations or ER visits
Treatment resistant symptomatic supraventricular or ventricular arrhythmias
Angina pectoris at rest, resistant to standard nitrate therapy
History of unexplained syncope
History of Cardiac Arrest or resuscitation

Co-morbidities: Pulmonary Disease Renal Disease

Symptoms often include:

Inability to carry on any physical activity without pain or SOB Pain and/or dyspnea increase with physical activity Increased fatigue

Orthopnea

Paroxysmal Nocturnal Dyspnea JVD

Cachexia or Weight Gain (edema)

Hospice Indicators for Dementia

Ability to speak is limited (6 words or less)
Speech is nonsensical
Non-ambulatory or ambulatory with assistance and history of falls
Incontinent of bowel and bladder
Dependent in ADLs
Stage 7 or higher on FAST scale
Decrease in cognitive status

Secondary Conditions may include:

Unintentional progressive weight loss of > 10% of body weight over the preceding 6 months
Serum albumin < 2.5 mg/dl
Dysphagia
Aspiration pneumonia
Urinary tract infection
Decubitus ulcers

Other co-morbidities

Hospice Indicators for Cancer

Disease progression in spite of treatment
Increasing pain and/or symptoms
Treatment toxicities outweigh benefits
Terminal prognosis

Treatment is having negative impact on patient’s quality of life

Hospice Indicators for Renal Disease

The patient is not seeking dialysis or renal therapy
Estimated GFR < 10 ml/min (<15 for diabetes)
Serum creatinine > 8.0 mg/dl (>6.0 mg/dl for diabetes)

Supplemental Indicators:

Presence of co-morbid conditions in acute renal failure may include:

Advanced cardiac disease, chronic lung disease, cachexia, or malnutrition (albumin < 3.5 gm/dl)

Presence of signs and symptoms in chronic renal failure such as:

Uremia, oliguria (<400 cc/day), hyperkalemia (>7.0) not responsive to treatment, hepatorenal

syndrome, uremic pericarditis or intractable fluid overload unresponsive to treatment.

Hospice Indicators for Liver Disease

End stage liver disease is present as evidenced by both:

INR > 1.5

Serum albumin < 2.5 gm/dl

And at least ONE of the following is present:

refractory ascites
spontaneous bacterial peritonitis
hepatorenal syndrome
refractory hepatic encephalopathy
recurrent variceal bleeding

Supporting factors may include:

progressive malnutrition
muscle wasting
active alcoholism
hepatocellular carcinoma
active Hepatitis B
treatment refractory Hepatitis C

Hospice Indicators for Pulmonary Disease

Severe, chronic lung disease as evidenced by:

Disabling dyspnea at rest, poorly responsive or unresponsive to bronchodilators
Increasing visits to the ER or prior hospitalizations for respiratory infections and/or respiratory failure

Hypoxia at rest on room air:

pO2 ≤ 55 mmHg
Oxygen saturation ≤ to 88%

Supplemental Hypercapnia:

pCO2 ≥ 50 mmHg

May Include Unintentional progressive weight loss:

>10% of body weight over the preceding 6 months

Resting tachycardia > 100/minute

Presence of cor pulmonale or right heart failure (RHF)

Stroke

Hospice Indicators for Neurological Diseases

Physician diagnosis of CVA with confirmation of non-recovery
Limitations with stroke may include one or more of the following (#1, #2 or #3):

Post Stroke Dementia with:
- Cannot dress, bathe or ambulate
- Incontinent of bowel and bladder, intermittent or constant
Poor functional status with PPS score of ≤50%
Poor nutritional status with the inability to maintain sufficient fluid or calorie intake with ONE of the following:
- > 10% wt loss during previous 6 months
- wt loss 7.5 % in previous 3 months
- serum albumin < 2.5 gm/dl
- current history of pulmonary aspiration
- severe dysphagia which requires significant downgrade in diet

Coma

Physician diagnosis of Coma with confirmation of non-recovery
Comatose patients with any three of the following on day three of coma:
- Abnormal brain stem response
- Absent verbal response
- Absent withdrawal to pain
- Serum creatinine > 1.5 mg/dl

These factors also support eligibility for hospice care

Aspiration pneumonia
Upper urinary tract infection (pyelonephritis)
Sepsis
Stage III – IV decubitus ulcers
Fever recurrent after antibiotics

Download the FAST scale to assess the Functional level of your loved one.

Call 815.939.4141

More Time, More Memories: Our Care Helps Families Stay Together Longer.

Each year, over 100 of our patients benefit from early hospice care, extending their time with family and loved ones by six months or more.

Hospice Care

When that time comes, hospice is there every step of the way with the patient and family as they focus on comfort at the end of life.

Palliative Care

Palliative care is a chance for people dealing with life-limiting illness to have relief from the symptoms, pain and stress of dealing with the illness and to have an extra layer of support.

Care Where You Are

Most patients receive hospice care in a private home. Yet did you know that UpliftedCare also provides care to those living in a nursing home, hospital or assisted living?

Complementary Therapies

Support services such as massage, respiratory therapy, music, and pet therapy can play a significant role in enhancing quality of life for those who are ill. From easing discomfort to evoking fond memories, these therapies can heal the body and lift the spirit.