Non-Cancer Diagnoses Referral Guide

ALS

  • Significant decline in function

  • Rapid progression of ALS

  • Affected respiratory status

  • Secondary conditions such as weight loss or recurrent infections

Heart Disease

  • Patient is symptomatic despite maximum medical management with diuretics and vasodilators

  • Shortness of breath with minimal activity

  • Significant symptoms of recurrent CHF at rest

HIV/AIDS

  • CD4+ count <25 OR viral load >100,000

  • Not responding to treatment

  • Weight loss

  • Comorbid conditions

  • Decreased performance status

Liver Disease

  • PT >5 over control or INR >1.5

  • Serum albumin <2.5

  • Secondary conditions such as:

    • Jaundice and/or ascites

    • Peritonitis

    • Hepatorenal syndrome

    • Hepatic encephalopathy

    • Recurrent variceal bleeding

Neurological Disease
(Alzehimer’s/Dementia)

  • Alzheimer’s that is FAST 7a*

  • Speaking ability limited to 5 words or less

  • Plus either:

    • Dependent in 3/6 ADLs with disease-related complications (weight loss 10%, etc.)

    • Significant comorbidity (heart failure, advanced cancer, COPD)

Lung Disease

  • Disabling dyspnea (SOB at rest/minimal exertion, continuous oxygen or chronic oral steroids)

  • Plus progressive disease (frequent ED visits, hospitalizations or cor pulmonale)

Renal Disease

  • Patient is not seeking the initiation of dialysis

  • Creatinine clearance <10cc/min • Serum creatinine >8.0 mg/dl

  • Not a candidate for transplant

Stroke

  • Unable to bathe/dress without assistance

  • Weight loss

  • Serum Albumin <2.5 gm/dl

  • Current history of pulmonary aspiration

  • Food and fluid intake is reduced

If the patient does not meet above guidelines but is still thought to be appropriate for hospice (e.g., has comorbidities, recent rapid decline), please call for an assessment.

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*SOURCES

  • Sclan, S. G., & Reisberg, B. (1992). Functional Assessment Staging (FAST) in Alzheimer’s disease: Reliability, validity, and ordinality. International Psychogeriatrics, 1992 (4), Supplement 1:55-69.