Twin Lakes Hospice, Inc.

General Guidelines for Admission

GENERAL CRITERIA FOR CANCER DIAGNOSIS AND OTHER DISEASE

• Life-limiting condition with prognosis of six months or less if disease progression runs its normal course
• Patient/Family informed that condition is life-limiting and have elected comfort/palliative care instead of curative care.
• Signs that disease process is progressing
• Frequent hospitalizations
• Progressive weight loss (taking into consideration swelling)
• Increasing weakness
• Fatigue
• Sleeping more
• Confusion
• Weakness, unable to help self, Deteriorating mental abilities
• Frequent infections, Skin breakdown
• Specific decline in condition

SPECIFIC SYMPTOMS FOR VARIOUS DIAGNOSES

• Pulmonary Disease
• Symptomatic at rest
• Fast breathing
• Shortness of breath
• Fast heart rate
• Oxygen dependent
• Fluid in the lungs
• Increased shortness of breath upon exertion (change from prior level of function)
• Increasing blueness of lips and hands
• Progressive cough
• Anxiety
• Unintentional weight loss
• Cardiac Disease
• Signs and symptoms of CHF at rest
• Shortness of breath
• Sweating
• Skin and bones
• Moist lungs
• Alteration in heart sounds
• Enlarged liver
• Edema
• Sporadic nighttime
• Shortness of breath
• Weakness
• Frequent medication adjustments
• Shortness of breath lying down and dizziness
• Increasing chest pain - duration and/or frequency
• Pale or ashen skin color
• Increased symptoms
• Ejection fraction < 20% (only if test results available)
• Neurological Disease
• General signs and symptoms of some neurological conditions/diseases including but not limited to Alzheimer's, other dementias, Parkinson's, Multiple Sclerosis, Amyotrophic Lateral Sclerosis (ALS), and Huntington's disease
• Increased weakness and unable to care for self
• Signs of bulbar involvement: increased trouble swallowing, talking, and breathing
• Difficulty or inability to speak
• Nutritional impairment with current episodes of aspiration pneumonia and weight loss
• Alzheimer's Disease
• Limited intelligible speech or inability to speak
• Inability to ambulate or sit up independently
• Unable to smile
• Social Isolation
• Repeated infections
• Progressive weight loss, unable to swallow effectively Low protein and serum albumin levels
• Difficulty or inability to hold head up independently
• Score of three or less on Mini Mental State Exam
• Skin breakdown
• Urinary and bowel incontinence
• Aids Criteria
• Must have established AIDS diagnosis
• Decision has been made to forego antiretroviral, antibacterial, antifungal, chemotherapeutic and prophylactic drug therapy related specifically to the AIDS diagnosis.
• Chronic, persistent diarrhea
• Significant weight loss of 10% or more in past three months
• Generalized weakness
• Persistent serum albumin < 2.5, Viral load > 100,000 copies ml, CD4 count < 50
• History of frequent opportunistic infections
• Liver Disease
• Not a candidate/does not desire liver transplantation resection
• Enlarged liver Jaundice
• Abdominal Swelling
• Malnutrition, Muscle wasting
• Weakness and unable to care for self
• Decreased urination
• Recurrent variceal hemorrhage (vomiting blood)
• Renal Disease
• Creatinine clearance of < 10cc/mn (< 15cc/min for diabetics AND serum creatinine > 8.0 mg/dl (> 6.0mg/dl for diabetics))
• Uremia
• Nausea/vomiting
• Itching
• Restlessness
• Urine output of < 400cc/24 hours
• Uncorrectable fluid overload
• Uncorrectable potassium level > 7.0 mEq/L
• Uremic pericarditis, Hepatorenal syndrome
• Patient has chosen not to have renal dialysis
• Stroke
• Recurrent infections
• Recurrent ministrokes
• Poor nutritional status
• Skin breakdown
• Paralysis
• Post stroke dementia
• Age typically > 70 years
• Comatose with any five of the following on Day 3 indicate poor long term survival (97% mortality rate within two months)
• Abnormal brain stem response
• Withdrawal response to pain is absent
• Age > 70 years
• Verbal response absent Tahoma
• Serum creatinine > 1.5mg/dl