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End of Life Online Curriculum - Modules

 

Home Hospice : Home Care of the Dying Patient

Advanced End Stage Senescence or Debility

The patient has:

  • Karnofsky Performance Status < 50% and
  • at least one of the following conditions within the past 12 months:
    • Aspiration pneumonia
    • Pyelonephritis or other upper urinary tract infection
    • Septicemia
    • Decubitus ulcers, multiple, stage 3-4
    • Fever, recurrent after antibiotics
    • Inability to maintain sufficient fluid and calorie intake with > 10% weight loss during the previous six months or a serum albumin of < 2.5 gm/dL.
  • Significant dysphagia with associated aspiration measured objectively (e.g., swallowing test or a history of choking/gagging with feeding).

A physician may determine that a patient has a life expectancy of six months or less even if the above findings are not present. Co-morbidities also support eligibility for hospice care.

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©End of Life Curriculum Project, a joint project of the US Veterans Administration and SUMMIT, Stanford University Medical School.
Funded by a grant to the Veterans Administration Nationwide Palliative Care Network by the National Library of Medicine. VJ Periyakoil, MD, Director.