There is often hesitancy when patients and their caregivers begin the discussion surrounding hospice care. Concerns that hospice means “giving up hope.” Another reason patients can be hesitant is the thought that they don’t have the “right” illness or prognosis for hospice.

While it is true that a majority of hospice patients are cancer patients nearing the end of life, many other conditions meet the criteria for hospice care. The basic criteria for hospice care eligibility is the patient has a life expectancy of six months or less, if the illness runs its normal course. There are also secondary conditions that Medicare recognizes as ones that impact prognosis.

Below is more information on three other advanced stage illnesses most often seen in hospice: dementia, heart disease, and lung disease.

Dementia

According to statistics from the Alzheimer’s Association, dementia is one of the top causes worldwide of disability and dependency among older adults. In 2023, 1 in 9 adults (10.8%) age 65 and older were living with Alzheimer’s dementia, and the CDC expects that number to nearly triple by 2060. With this rise in cases, dementia is expected to become more prominent in hospice care over the next few decades.

When recommending hospice care for patients with dementia, doctors and care teams look for a combination of factors. The patient must be at Stage 7C or beyond according to the FAST (Functional assessment Staging Tool) scale and also one or more of the following criteria in the last 12 months:

  • Aspiration pneumonia
  • Pyelonephritis
  • Septicemia
  • Multiple pressure ulcers (stage 3-4)
  • Recurrent Fever
  • Inability to maintain sufficient fluid and calorie intake in the past 6 months (10% weight loss or albumin <2.5)
  • Other significant condition that suggests a limited prognosis

Heart Disease

Hospice care for heart disease (heart attack or strokes) can be an under-utilized treatment with many contributing factors such as burdens of symptoms that need frequent comfort interventions (IV medicines) and unpredictability of the disease. However, that is changing. According to Concordance Healthcare, “In 2016-2017, there was an increase in the percentage of hospice patients with heart disease, from 13.4 percent to 14.7 percent.”

The secondary criteria for hospice care for a patient with heart disease usually start with a classification of congestive heart failure Class IV on the New York Heart Association scale. Then doctors look for the following:

  • Inability to carry out minimal physical activity without dyspnea or angina 

AND 

  • Optimally treated: diuretics, vasodilators, ACEI, hydralazine, nitrates 

OR 

  • Angina at rest, resistant to standard nitrate tx, and either not a candidate for/or declined invasive procedures

Lung Disease

According to the American Lung Association, approximately 11.7 million adults live with chronic obstructive pulmonary disease (COPD) in America. While that number has dropped some in recent years, it is still a major concern for doctors. Patients who suffer from Stage 4 COPD are more likely to enter hospice care. 

The contributing factors that lead a care team to recommend hospice care for these patients include:

  • Disabling dyspnea at rest
  • Little/no response to bronchodilators
  • Decreased functional capacity including bed-to-chair existence, fatigue, cough

AND

  • Progression of disease including recent increasing office, home, ED visits and/or hospitalizations for pulmonary infection and/or respiratory failure

AND

  • Documentation within the past 3 months:
    • RA hypoxemia at rest (p02 <55 by ABG)
    • or 02 sat <88%
    • or hypercapnia pC02 >50

There are, of course, many other illnesses and conditions that can place a patient in hospice care. It is important to talk with the patient’s doctor and care team to see if hospice care may be the right decision. They can look at every factor in the patient’s history to make the most informed decision. 

When determining if hospice is the right decision for yourself or a loved one, the Heart to Heart Hospice survey Is it Time for Hospice? may be helpful. Find a Heart to Heart location near you or refer a loved one to our services.