Often, medical professionals wait too long to refer their patients to Helios Care for support at home during a progressive serious illness. Even if a patient isn’t eligible for or emotionally ready for hospice care, Helios Palliative Care can keep symptoms under control. And many patients are ready for Helios Hospice Care long before their final weeks or days. The sooner you make a referral to Helios Care, the more we can do to help your patients feel better and live better. Check out Helios Hospice Care admission criteria below.
Admission Criteria
Is Helios Care right for your patient?
Considerations for referring a patient
Benefits and guidelines of admitting
patients to Helios Hospice Care
A vital question is “What does your patient want?” In general, each patient wants to feel better and live better despite their serious illness. The factors contributing to fulfilling your patients’ goals and wishes are provided by Helios Hospice Care:
- They want to be home
- To be free from pain and symptoms
- To enjoy and make the most of their time left
- An extra layer of care and support at home for their loved ones
- To not be a financial burden to their loved ones
- No more trips to the hospital or ER
- No more invasive or aggressive treatments
- Access to personalized and specialized care 24/7
- To be home when they die
- 13 months of grief support for all family members
Consider these general guidelines that indicate it’s time for Helios Hospice Care:
- Life-limiting condition
- Would you be surprised if your patient died in the next six months?
- Symptoms and signs that paint a picture of decline
- More than one visit to the hospital/ER/your office for their illness
- Recurring infections
- Patient focus on symptom relief and comfort rather than cure
- Progression of disease(s)
- Evidence of weight loss; serum albumin < 2.5g/dl
- Karnofsky or Palliative Performance Scale score < 50%
- Dependence in at least two ADLs
- Progressive/unhealing stage III or IV pressure ulcers
Hospice admission criteria by specific disease
Two or more items in any category should generate a referral to Helios Hospice Care. Click on a “+” sign to see criteria.
Cancer
- Clinical findings of malignancy with widespread, aggressive or progressive disease as evidenced by increasing symptoms, worsening lab values and/or evidence of metastatic disease
- Impaired performance on Palliative Performance Scale of < 70%
- Refuses further curative therapy or continues to decline despite definitive therapy
- Hypercalcemia > or = 12
- Cachexia or weight loss of 5% in the preceding 3 months
- Recurrent disease after surgery/radiation/chemotherapy
- Refusal to pursue additional curative or prolonging cancer treatment
- Signs and symptoms of advanced disease (nausea, anemia, malignant ascites or pleural effusion, etc.)
HIV
- CD4 count < 25 cells/mcl or persistent viral load >100,000 copies/ml
- Decreased performance status
- Supporting factors
- Chronic persistent diarrhea
- Persistent serum albumin < 2.5
- Concomitant substance abuse
- Age > 50
- Advanced AIDS dementia complex
- CHF or advanced liver disease
Dementia
- Functional assessment score = 7
- Unable to ambulate without assist
- Unable to dress or bathe without assist
- Urinary and fecal incontinence, intermittent or constant
- No consistently meaningful verbal communication
- Complications such as aspiration pneumonia, UTI, septicemia, recurrent fevers
- Decubitus ulcers stage 3 or 4
- Weight loss of >10% over last six months
ALS
- Critically impaired respiratory function
- Dyspnea at rest
- Use of accessory muscles
- Respiratory rate > 20
- Reduced speech/vocal volume
- Unexplained headaches, anxiety or nausea
- Severe nutritional insufficiency
- Progressive weight loss of at least 5% of body weight with or without gastrostomy tube insertion
Renal Disease
Renal Disease – Acute Renal Failure
- Patient is not seeking dialysis or transplant
- Creatinine > 8mg/dl (> 6mg/dl for diabetics)
- GFR < 10ml/min
- Creatinine clearance < 10cc/min (< 15cc/min for diabetics)
- Co-morbid conditions
Renal Disease – Chronic Renal Failure
- Patient is not seeking dialysis or transplant
- Creatinine clearance < 10cc/min (<15cc/min for diabetics)
- Creatinine > 8mg/dl (> 6mg/dl for diabetics); GFR < 10ml/min
- Symptoms: uremia; oliguria; confusion; nausea; vomiting; pruritus; restlessness; hyperkalemia > 7.0, not responsive to treatment; intractable fluid overload, not responsive to treatment
Liver Disease
- PTT > 5 seconds over control
- Serum albumin < 2.5gm/dl
- End-stage liver disease
- Ascites refractory to treatment
- Spontaneous bacterial peritonitis
- Hepatorenal syndrome
- Hepatic encephalopathy, refractory to treatment
- Supportive factors
- Progressive malnutrition
- Continued alcoholism
- Hepatocellular carcinoma
Cardiac Disease
- Symptomatic despite optimal treatment with diuretics and vasodilators
- Recurrent CHF
- Ejection fraction < 20%
- New York Heart Association Class IV
- Supporting factors
- Arrhythmias are resistant to treatment
- History of cardiac arrest or resuscitation
- History of unexplained syncope
- Cardiogenic embolic disease (e.g., CVA)
Respiratory Disease
- Severe chronic lung disease
- Disabling dyspnea at rest, poorly responsive to bronchodilators
- FEV1 after bronchodilator < 30%
- Progression of end-stage pulmonary disease
- Recurrent pulmonary infections
- Hypoxemia at rest, on room air: PO2 < 55mmHg – or O2 sat < 88%
- Right heart failure secondary to pulmonary disease
- Unintentional progressive weight loss > 10%
- Persistent resting tachycardia
Stroke/Coma
- Karnofsky Performance < 40%
- Inability to maintain nutrition/hydration
- Weight loss > 10%
- Serum albumin < 2.5 gm/dl
- Pulmonary aspiration
- Severe dysphagia
- Coma with any three of the following on day three of coma:
- Abnormal brain stem response
- Absent verbal response
- Absent withdrawal response to pain
- Serum creatinine > 1.5 mg/dl
Malnutrition
- BMI < 22 despite nutritional support
- PPS = or < 40%
- Continued nutritional decline
Is Helios Palliative Care right for your patient?
If a patient of yours doesn’t meet the criteria or isn’t emotionally ready for hospice care, Helios Palliative Care may be able to help. Consider these guidelines for referring a patient to Helios Palliative Care.
- Progressive serious illness with a life expectancy of more than six months
- Uncontrolled pain and/or other persistent symptoms
- A desire to continue curative treatment
- Repeated trips to the ER or frequent calls to your office for help
- A need for an extra layer of support at home, including for their family caregivers
- Connections to other community resources and education about their disease
Make a referral
Call us anytime at 607.432.5525 or complete and return our referral form.