Patient meets the following:
CANCER- Clinical findings of malignancy with widespread, aggressive or progressive disease
- Unable to do normal work with significant weight loss in the past 3 months
- Refuses further life-prolonging therapy or continues to decline in spite of definitive therapy
- Refuses dialysis or renal transplant
- Uremia (abnormally high levels of waste products in the blood)
- Oliguria (production of abnormally small amounts of urine)
- Ambulatory ability is lost & cannot walk without assistance
- Speech is limited to less than 6 meaningful words in an average day
- Presence of pressure ulcer or bedsores
- Inability to maintain sufficient fluid and calorie intake in the past 6 months
- Significant weight loss in the past 3 months
- Has been optimally treated for heart disease
- Inability to carry out minimal physical activities without shortness of breath or chest pain
- Refractory ascites
- Hepatorenal syndrome (elevated creatinine & BUN with oliguria)
- Hepatitis C
- Progressive malnutrition
- Ongoing alcoholism
- Disabling shortness of breath at rest
- Little to no response to bronchodilators
- Decreased functional capacity
- Unintentional progressive weight loss over the last 6 months
(Amyotrophic Lateral Sclerosis, Parkinson’s disease, Muscular Dystrophy, Myasthenia Gravis or Multiple Sclerosis)
- Critically impaired breathing capacity with shortness of breath at rest and/or needs oxygen at rest
- Wheelchair or bed-bound status from independent ambulation
- Barely unintelligible speech
- Major assistance on most activities of daily living
- Decreased oral intake with continuing weight loss
- Mainly in bed
- Unable to do any work and needs total assistance on most activities of daily living
- Significant weight loss for the past 6 months
- History of pulmonary aspiration without response to therapy interventions to decrease dysphagia and decrease aspiration
If the patient does not meet any of the above guidelines, the patient may still be eligible if the prognosis is less than 6 months.
Symptoms cannot be managed in any other settings that require intravenous medications, uncontrolled shortness of breath that requires the use of oxygen, frequent suctioning, and intensive wound care.