You may want to consider hospice care as an option when:
Core indicators
- The patient and family choose comfort care.
- There is loss of function and a physical decline.
- The patient needs help with daily activities such as bathing and dressing.
- There are more visits to the Emergency Room.
- The patient has many different illnesses, all taking a toll on his or her day to day existence.
When is the best time to start hospice care?
Most patients and families who receive hospice care say they wish they had known about it earlier, that they needed the help much sooner than they received it. Research has shown that hospice can increase both the quality of life and how long a patient lives. Families who receive hospice near the very end–just a few days to a week–have been shown to have a harder time adjusting during the bereavement period than do those whose loved one receives hospice care for weeks and months before passing on. If you even think that your family and the person you care for could benefit from pain or symptom management, assistance with bathing and grooming, emotional and spiritual support, and telephone access to caregiving advice, ask your physician if hospice might be a service to consider. Experts agree that at least two to three months of care is optimal. It is better to ask sooner rather than later so you do not regret having missed the support that hospice has to offer.
Disease specific Indicators
Here’s a link to this Table as a Microsoft Word Document (30 KB)
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Cancer
|
The cancer has spread to multiple sites in the body |
| There has been weight loss | |
| The patient and family choose palliative, or comfort care | |
|
Heart Disease
|
Has discomfort with physical activity |
| Has heart disease symptoms despite maximum medical management | |
| Has irregular heart beat which won’t respond to medicine | |
| Has had cardiac arrest | |
| Has had a stroke as a result of a blood clot being released from the heart | |
|
Dementia
and/or General Decline |
Unable to walk without assistance |
| Patient is unable to control urine and feces | |
| Speech is limited to a few words | |
| Unable to dress without assistance | |
| Unable to sit up or hold head up | |
| Complications occur such as bed sores, pneumonia, urinary tract infections | |
| Difficulty swallowing or eating | |
| Weight loss | |
|
Pulmonary Disease
|
Short of breath at rest |
| Bronchodilators do not work well any more | |
| Recurrent lung infections | |
|
Right sided heart failure/cor pulmonale
|
|
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Weight loss
|
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| Fast heart beat, even when resting | |
| Low oxygen levels in blood and high carbon dioxide levels in blood | |
|
ALS |
Unable to walk and needs assistance with day to day activities |
|
Barely understandable speech
|
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Difficulty swallowing
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Weight loss
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| Significant shortness of breath | |
|
Other ongoing illnesses such as pneumonia, urinary tract infections
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HIV/AIDS
|
Wasting syndrome (huge weight loss)
|
| Central nervous system lymphoma | |
| Kaposi’s sarcoma | |
|
AIDS dementia (severe confusion)
|
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Patient decides not to take antiretrovirals or AIDS medicines
|
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Patient has other illnesses together with AIDS and/or severe infection
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LIVER DISEASE
|
Patient is not a liver transplant candidate |
| Patient has a large amount of fluid in abdomen, despite taking medicine for this | |
|
Patient has infection in abdomen
|
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Hepatorenal syndrome – progressive renal failure
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Patient has confusion which is also associated with sleepiness and coma
|
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Recurrent variceal bleeding (bleeding from the veins in the esophagus which have become distended)
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STROKE & COMA
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Patient not always alert and aware of surroundings |
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Patient is in a coma or vegetative state
|
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Patient has difficulty swallowing
|
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| Patient is paralyzed | |
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There is dementia after a stroke
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Despite artificial nutrition there is continued weight loss
|
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| The patient has other ongoing illnesses (pneumonia, etc.) | |
|
RENAL DISEASE
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No dialysis, no renal transplant
|
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Uremia – symptoms include confusion, nausea, pruritus and restlessness
|
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Increased swelling of fluid in body despite taking medicine for this
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Very low levels of urine production – less than 400cc each day
|
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| High potassium levels in blood |
Here’s a link to this Table as a Microsoft Word Document (30 KB)