Patient Referral

Hospice is a program for palliative care, with the primary goal of comfort, during the last 6 months of someone’s life. Predicting when someone has a 6-month prognosis, of course, is not a precise science. Below are some useful guidelines to assist in determining a 6-month prognosis. These are only guidelines, and not “rules.” Any patient that a physician feels has a less than 6-month prognosis is appropriate for referral.   Commonly, someone may have multiple conditions (for example, COPD and heart failure) that combined may be felt to have a less than 6-month prognosis.

Heart Disease

Symptoms at rest (NYHA class 4), shortness of breath from talking, despite optimal management; Left Ventricular ejection fraction of less than 20%.

Lung Disease

Symptoms at rest despite optimal management.

Alzheimer’s Dementia and Related Disorders

Speaking less than 6 words in a day (FAST score of at least 7a) + a secondary condition (e.g. delirium episodes, stage 3 or 4 pressure ulcer, 10% weight loss) or comorbid condition (e.g. Heart Failure, COPD, chronic kidney disease, chronic liver disease.)

Liver Disease

PT/INT greater than 1.5; Serum albumin less than 2.5, plus:

    – Ascites that is refractory to treatment or

    – History of spontaneous bacterial peritonitis or

    – Hepatic encephalopathy or

    – Recurrent variceal bleeding or

    – Concomitant renal disease

Renal Disease

Deciding to stop dialysis or choosing not to start dialysis (creatinine clearance of 15 or less).


Usually 6 month or less prognosis as defined by oncologist. Generally, should have advanced disease with metastases.


Requiring total or nearly total assistance with all activities of daily living and

– Lack of intake sufficient to sustain life and no life-sustaining interventions (choose not to have a feeding tube).

– Having a secondary condition that may shorten prognosis may be taken into account (e.g. Heart Failure, COPD, chronic kidney disease,  chronic liver disease)