top of page

When to make a hospice referral

These guidelines will help identify residents/patients with non-cancer diagnosis who may be eligible for hospice services. They are guidelines only. If you think someone could benefit from hospice services, please call.

Dementia/Alzheimer’s and Failure to Thrive

  • Spends most of time in bed or chair

  • Requires assistance with most ADL’s

  • Incontinent of Bowel and/or bladder

  • Unable to speak more than 7 words daily

  • Co-morbid conditions such as:

    • Pressure Ulcers

    • Recurrent infections

    • Serum Albumin <2.5 gm/dl

    • Significant weight loss or BMI <22


Renal Disease

  • Not seeking dialysis

  • Elevated BUN and creatinine

  • Creatinine clearance or GFR <10ml/minute

    • (<15ml//min with diabetes

  • Urine Output of <400ml/day

  • Cachexia or massive edema


Liver Disease

  • Pt >5 seconds above control or INR >1.5

  • Serum albumin >/= 2.5 gm/dl

  • At least one of the following:

    • Elevated BUN and creatinine w/decreased urinary output

    • Ascites

    • Spontaneous bacterial peritonitis

    • Hepatic encephalopathy

    • Recurrent  variceal bleeding

Pulmonary Disease

  • Disabling dyspnea at rest or with minimal activity

  • Increased ER visits or hospitalizations for pulmonary diagnosis

  • Hypoxemia at rest on room air, 02 sat <89% or PC02 >/50mm/hg

  • Resting heart rate > 100 bpm

  • Unintentional weight loss of 10% or more over preceding 6 months


  • Recent decline in functional status and/or significant change

  • Recent weight loss or impaired nutritional status, serum albumin <2.5 gm/dl, BMI ,22

  • Pulmonary aspiration events

  • Dependence in 3 or more of the following:

             Feeding    Bathing   Transfers

             Dressing   Toileting

             Heart Disease

  • Poor response to optimal treatment with diuretics and vasodilators

  • Significant symptoms at rest and unable to carry on physical activity without symptoms

  • Chest pain at rest, resistant to nitrate therapy

  • History of cardiac  arrest or resuscitation

  • Documentation of ejection fraction of 20% or less.

bottom of page