Helping Our Patients and Their Families

Embrace Life to the Fullest


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RENAL FAILURE

The patient has 1, 2, and 3.
1. The pat is not seeking dialysis or renal transplant
AND
2. Creatinine clearance* is < 10 cc/min (<15 for diabetics)
AND
3. Serum creatinine > 8.0 mg/dl (> 6.0 mg/dl for diabetics)
Supporting documentation for chronic renal failure includes:
Uremia, Oliguria (urine output < 400 cc in 24 hours), Intractable hyperkalemia (> 7.0), Uremic pericarditis,
Hepatorenal syndrome, Intractable fluid overload.
Supporting documentation for acute renal failure includes:
 Mechanical ventilation, Malignancy (other organ system)
Chronic lung disease, Advanced cardiac disease,
Advanced liver disease

 STROKE OR COMA

The patient has both 1 and 2.
1. Poor functional status PPS* ≤ 40% AND
2. Poor nutritional status with inability to maintain sufficient fluid and calorie intake with ≥1 of
the following:
≥ 10% weight loss in past 6 months
≥7.5% weight loss in past 3 months
 Serum albumin <2.5 gm/dl
 Current history of pulmonary aspiration without effective response to speech therapy interventions to improve dysphagia and decrease aspiration events
Supporting documentation includes:
Coma (any etiology) with 3 of the following on the third (3rd) day of coma:   Abnormal brain stem response, Absent verbal responses,  Absent withdrawal response to pain, Serum creatinine > 1.5 gm/d

CANCER

Patient meets ALL of the following:
1.Clinical findings of malignany with widespread, aggressive or progressive disease as evidenced by increasing sx, worsening lab values and/or evidence of metastatic disease
2.Palliative performance Scale (PPS) ≤ 70%
3.Refuses further life-prolonging therapy OR continues to decline in spite of definitive therapy
Supporting documentation includes:
Hypercalcemia > 12, Cachexia or weight loss of 5% in past 3 months,  Recurrent disease after surgery/radiation/chemotherapy
Signs and sx of advanced disease (e.g. nausea, requirement for transfusions, malignant ascites or pleural effusion, etc.)

 ALZHEIMERS

The patient has both 1 and 2:
1. Stage 7C or beyond according to the FAST Scale
AND
2. One or more of the following conditions in the 12 months:
Aspiration pneumonia
Pyelonephritis
Septicemia
Multiple pressure ulcers ( stage 3-4)
Recurrent Fever
Other significant condition that suggests a limited prognosis
Inability to maintain sufficient fluid and calorie intake in the past 6months ( 10% weight loss or albumin < 2.5 gm/dl)

Is it time for Hospice?

The Embrace Hospice team is available 24 hours a day, 7 days a week in greater San Antonio, to speak to you, provide hospice care and be there when you need us most.   210.691.3600

     info@embracehospicellc.com

@SAHospice

Hundreds of times each year, patients and families tell us: "We wish we'd entered the hospice program sooner." It is a common misconception that hospice care is only for the last few days of life when, in fact, patients and families can benefit most when they have hospice for the several months during this stage in life.       


Hospice care is the best choice for you and your family when you and your doctor decide to focus on bringing comfort to your illness rather than continuing aggressive treatments intended to cure your disease.  

       
Common Hospice Diagnoses And Guidelines For Admission to Hospice in San Antonio

LIVER DISEASE


The patient has both 1 and 2

1.End stage liver disease as demonstrated by A or B, and C:

A. PT>5 sec OR B.

AND

C. Serum Albumin<2.5 gm/dl

AND

2. One or more of the following conditions:

Refractory Ascites,h/o spontaneous bacterial peritonitis,

Hepatorenal syndrome, refractory encephalopathy, h/o recurrent variceal bleeding

Supporting Documents include:

Progressive malnutritions, Muscle wasting with dec. strentgth

Ongoing alchoholism (>80 gm ethanol/day), Hepatocellular CA HBsAg postivice. Hep C refractory to treatment

San Antonio Area Hospice Team Available 24/7

​210.691.3600



HEART DISEASE
The patient has 1 and either 2 or 3. 
1. CHF with NYHA Class IV* sx and both :
 Significant sx at rest
 Inability to carry out even minimal physical activity without dyspnea or angina
2. Patient is optimally treated (ie diuretics, vasodilators, ACEI, or hydralazine and nitrates)
3. The patient has angina pectoris at rest, resistant to standard nitrate therapy, and is either not a candidate for/or has declined invasive procedures.
Supporting documentation includes:
 EF ≤ 20%, Treatment resistant symptomatic dysrhythmias  h/o cardiac related syncope, CVA 2/2 cardiac embolism  H/o cardiac resuscitation, concomitant HIV disease


 PULMONARY DISEASE

Severe chronic lung disease as documented by 1, 2, and 3.
1. The patient has all of the following:
 Disabling dyspnea at rest
 Little of no response to bronchodilators
 Decreased functional capacity (e.g. bed to
chair existence, fatigue and cough)
AND
2. Progression of disease as evidenced by a recent h/o increasing office, home, or ED visits and/or hospitalizations for pulmonary infection and/or respiratory failure.
AND
3. Documentation within the past 3 months ≥1:
 Hypoxemia at rest on room air (p02 < 55 mmHg by ABG) or oxygen saturation < 88%
 Hypercapnia evidenced by pC02 > 50 mmHg
Supporting documentation includes: Cor pulmonal and right heart failure Unintentional progressive weight loss

 NEUROLOGIC DISEASE

(chronic degenerative conditions such as ALS, Parkinson’s, Muscular Dystrophy, Myasthenia Gravis or Multiple Sclerosis)

The patient must meet at least one of the following criteria (1 or 2A or 2B):
1. Critically impaired breathing capacity, with all:
Dyspnea at rest, Vital capacity < 30%, Need O2 at rest, patient refuses artificial ventilation
OR
2. Rapid disease progression with either A or B below:
 Progression from :
independent ambulation to wheelchair or bed-bound status
normal to barely intelligible or unintelligible speech
normal to pureed diet
independence in most ADLs to needing major assistance in all ADLs
AND
A. Critical nutritional impairment demonstrated by all of the following in the preceding 12 months:
 Oral intake of nutrients and fluids insufficient to sustain life
 Continuing weight loss
 Dehydration or hypovolemia
 Absence of artificial feeding methods
OR
B. Life-threatening complications in the past 12 months as demonstrated by ≥1:
 Recurrent aspiration pneumonia, Pyelonephritis, Sepsis,
Recurrent fever, Stage 3 or 4 pressure ulcer(s