SECTION 2: DISEASE SPECIFIC GUIDELINES

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These guidelines should be used as a starting point if the patient has one of the following diseases:(Click on each disease to learn more)

Cancer ALS  Alzheimer’s Disease Heart Disease HIV /AIDSLiver Disease Lung Disease Kidney Disease Stroke  Coma 

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ABOUT THIS SECTION

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If a patient has one of the disease we just listed, he or she needs to meet the guidelines in Section 2 AND the guidelines for his or her specific disease in Section 3 in order to be eligible for hospice care.

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A. CAN THE PATIENT PERFORM NORMAL DAILY TASKS WITHOUT HELP?

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Doctors measure a patient’s ability to perform normal daily tasks using a scale called the Karnofsky Performance Status Scale . Another type of scale that could be used is the Palliative Performance Scale.  Both of these scales go from 100% to 0%. 100% means the patient is able to perform normal daily tasks without any help. 0% means the patient has died.

If the patient scores less than 70% on either the Karnofsky Performance Status Scale or the Palliative Performance scale, they meet this guideline for hospice eligibility. Does the patient meet this guideline?

YES NO

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B. DOES THE PATIENT NEED HELP PERFORMING THESE TASKS?

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Walking

Going to the bathroom

Moving from one position to another

Getting dressed

Eating

Taking a bath or shower

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YES

YES

YES

YES

YES

YES

C. OTHER DISEASES

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The next set of slides will describe several diseases that the patient might have. These diseases would be in addition to the disease that causes the patient the most trouble. Additional diseases, called co-morbidities, can limit how long a patient will live.

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COPD

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COPD stands for Chronic Obstructive Pulmonary Disease. COPD is a group of lung diseases in which something (like an inflamed esophagus, mucus, or something else) blocks the patient’s airway and makes it difficult for them to breathe. COPD is most common in heavy smokers.

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Does the patient have COPD?

YES NO

CONGESTIVE HEART FAILURE

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Congestive heart failure happens when the patient’s heart has become weak and cannot pump enough blood to the rest of the body. This causes the patient’s kidneys to make the body hold on to more water, making the body “congested.”

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Does the patient have Congestive Heart Failure?

YES NO

ISCHEMIC HEART DISEASE

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Ischemia means “not enough blood.” In Ischemic heart disease, the heart itself is not getting enough blood to work properly. This is usually because the patient’s arteries are blocked by cholesterol or blood clots, but other problems could keep blood from getting to the heart too. Symptoms of ischemic heart disease are chest pain and weakness.

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Does the patient have Ischemic Heart Disease?

YES NO

DIABETES

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Diabetes, also known as diabetes mellitus, is a disease in which the patient’s blood sugar is too high. This can be because the patient’s pancreas doesn’t produce enough insulin (the chemical that regulates blood sugar) or because the patient’s body doesn’t respond to the insulin that the pancreas makes. Symptoms of diabetes include having to urinate more often and being hungry and thirsty very frequently.

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Does the patient have diabetes?

YES NO

PARKINSON’S DISEASE

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Parkinson’s disease is a brain and nerve disease that causes shaking and inability to control movement. It happens when the brain cells that produce dopamine die off. Dopamine is the chemical that allows nerves to control how muscles move.

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Does the patient have Parkinson’s disease?

YES NO

MULTIPLE SCLEROSIS

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Multiple sclerosis is a disease that happens when the patient’s immune system attacks her nerves and destroys the protective covering on the nerves. Multiple sclerosis causes the sufferer to have trouble controlling the part of the body that is being attacked. For instance, if the leg muscles are attacked, the patient would have difficulty walking. If the bladder is attacked, the patient would lose control of their bladder. Does the patient have multiple sclerosis?

YES NO

LOU GEHRIG’S DISEASE

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Lou Gehrig’s disease is a common name for amyotrophic lateral sclerosis, or ALS. ALS happens when the patient’s nerve cells die over time. This causes the patient to slowly lose control of their muscles and become paralyzed.

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Does the patient have Lou Gehrig’s Disease?

YES NO

STROKE

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A stroke happens when part of the brain doesn’t get enough blood and the brain cells die. Stroke symptoms depend on what part of the brain the stroke happens in, but can include loss of muscle control or paralysis in the parts of the body controlled by the part of the brain that lost blood.

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Has the patient had a stroke?

YES NO

Does the patient have kidney failure?

YES NO

KIDNEY FAILURE

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Kidney failure is when the kidneys can't filter waste out of the patient's blood well enough. The build up of waste chemicals in the patient's blood causes damage to other parts of the body as the kidney failure gets worse.

LIVER DISEASE

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In this case, liver disease could be any disease that mostly affects the liver and could limit the patient’s life to six months or less.

Does the patient have liver disease?

YES NO

NEOPLASIA

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Neoplasia is the growth of tumors throughout the body, or the growth of abnormal cells in the patient's body.

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Does the patient have neoplasia?

YES NO

DEMENTIA

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Dementia is when the patient loses the use of parts of their brain. This causes the loss of the ability to think, reason, and remember. Patients with dementia may also have trouble speaking and understanding what is being said to them. There are several diseases that can cause dementia, including Alzheimer's disease.Does the patient have dementia?

YES NO

HIV/AIDS

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HIV stands for human immunodeficiency virus. HIV is a virus associated with acquired immunodeficiency syndrome (AIDS). HIV/AIDS weakens the patient’s immune system so that the patient’s body can’t fight off other illnesses. AIDS is the final stage of an HIV infection.

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Does the patient have HIV/AIDS?

YES NO

LUPUS

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Lupus is a disease in which the body attacks its own healthy tissue, including skin, joints and organs. The cause is not known. Symptoms include chronic pain and swelling in the affected areas. Does the patient have lupus?

YES NO

RHEUMATOID ARTHRITIS

NEXTHOME

Rheumatoid arthritis is the long term inflammation (swelling and pain) of joints. This happens when the body attacks its own tissues near the joints.

Does the patient have rheumatoid arthritis?

YES NO

Yes to Stroke

Next On your worksheet, write:“The patient also has had a

stroke” When ready, select, “Next”

Yes to help with transfer

Back On your worksheet, write:“The patient needs help

transferring from one spot to another.”

Select “Back” when ready

Yes to Kidney Failure

Next On your worksheet, write:“The patient also has kidney

failure” When ready, select, “Next”

Yes to help getting dressed

Back On your worksheet, write:“The patient needs help getting

dressed.” When ready, select “back”

Yes to Dementia

Next On your worksheet, write:“The patient also has dementia” When ready, select, “Next”

Yes to Neoplasia

Next On your worksheet, write:“The patient also has neoplasia” When ready, select, “Next”

Yes to HIV/AIDS

Next On your worksheet, write:“The patient also has HIV/AIDS” When ready, select, “Next”

Yes to Liver Disease

Next On your worksheet, write:“The patient also has liver

disease” When ready, select, “Next”

Yes to Lupus

Next On your worksheet, write:“The patient also has lupus” When ready, select, “Next”

Yes to help bathing

Back On your worksheet, write:“The patient needs help

bathing.” Select “Back” when ready

Yes to rheumatoid arthritis

Next On your worksheet, write:“The patient also has rheumatoid

arthritis.” When ready, select, “Next”

Yes to trouble eating

Back On your worksheet, write:“The patient needs help eating.” Select “Back” when ready

Yes to help with bathroom

Back On your worksheet, write:“The patient needs help going to

the bathroom.” Select “Back” when ready

Yes to Trouble Walking

Back On your worksheet, write:“The patient needs help walking”

Select “back” when ready.

Palliative Performance Scale

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See an Example

Learn More

The Palliative Performance Scale (PPS) is similar to the Karnofsky Performance Status Scale but it is used for patients receiving care to relieve pain (palliative care).

Karnofsky Performance Status Scale

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The Karnofsky Performance Status Scale (KPS) is a questionnaire that doctors use to figure out how much the patient’s disease keeps them from performing daily tasks.

Yes on Karnofsky Scale

Next On your worksheet, write “The patient scored less than

40% on the Karnofsky Performance Scale.”

Choose “Next” when ready

Cancer

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Cancer is a group of diseases in which diseased cells grow out of control in the patient’s body. Cancer comes in a lot of different forms and can affect a specific part of the body or lots of different parts of the body. It can start in one part of the body and spread to other parts. Different types of cancer cause different symptoms, and are treated differently.

ALS

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ALS stands for Amyotrophic Lateral Sclerosis. It is also known as Lou Gehrig’s disease, after a famous baseball player who suffered from it. ALS causes nerve cells to die off so that they can’t control muscle movement any more. This causes the patient to become paralyzed overtime.

Alzheimer’s Disease

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Alzheimer’s disease is a form of dementia that gets worse over time. Dementia is a condition in which the brain loses its ability to think, reason, and remember things. Scientists don’t really know what causes Alzheimer’s disease yet.

Heart Disease

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In this case, heart disease could be any kind of disease that mostly affects the patient’s heart and could limit the patient’s life to six months or less.

HIV/AIDS

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HIV stands for human immunodeficiency virus. HIV is a virus associated with acquired immunodeficiency syndrome (AIDS). HIV/AIDS weakens the patient’s immune system so that the patient’s body can’t fight off other illnesses.

Liver Disease

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In this case, liver disease could be any disease that mostly affects the liver and could limit the patient’s life to six months or less.

Lung Disease

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Diseases that affect the lungs are also called pulmonary diseases. In this case, lung disease could be any disease that mostly affects the lungs and could limit the patient’s life to six months or less.

Kidney Disease

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Diseases that affect the kidneys are also called renal diseases. In this case, kidney disease could be any disease that mostly affects the kidneys and could limit the patient’s life to six months or less.

Stroke

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A stroke happens when blood stops flowing to part of the patient’s brain. This causes brain cells in that part of the brain to die. Depending on where in the brain the cells died, patients can lose their bodies’ abilities to perform different functions.

Coma

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A coma is when a patient has been unconscious for more than six hours, can’t be awakened, doesn’t respond to things that should case pain, doesn’t have a normal sleep cycle and can’t feel, speak, hear or move.

Yes to COPD

Next On your worksheet, write:“The patient also has COPD”

Select “Next” when ready.

Yes to Congestive Heart Failure

Next On your worksheet, write,“The patient also has congestive

heart failure.” When ready, select “Next”

Yes to Ischemic Heart Disease

Next On your worksheet, write:“The patient also has Ischemic

Heart Disease” When ready, select “Next”

Yes to Diabetes

Next On your worksheet, write, “The patient also has diabetes” When ready, select “Next”

Yes to Parkinson’s Disease

Next On your worksheet, write:“The patient also has Parkinson’s

disease” When ready, select, “Next”

Yes to Multiple Sclerosis

Next On your worksheet, write:“The patient also has Multiple

Sclerosis” When ready, select, “Next”

Yes to Lou Gehrig’s Disease

Next On your worksheet, write:“The patient also has Lou

Gehrig’s disease” When ready, select, “Next”

NEXT STEPS

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This is the end of Section 2. In order for the patient to be considered eligible for hospice care you must also complete the section 3 component that matches the patient’s disease. You may either go on to Section 3 now, by selecting the patient’s disease from the list below, or exit and come back later by selecting “EXIT”. You may also restart Section 2 by selecting “HOME”

Section 3 Components (Select patient’s disease) Cancer ALS  Alzheimer’s Disease Heart Disease HIV /AIDS

Liver Disease Lung Disease Kidney Disease Stroke  Coma

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