How Do I Know?

What is the patient’s disease and current condition?

The National Hospice and Palliative Care Organization (NHPCO) estimates that the most common disease and conditions associated with hospice care are:

• Cancer (28%)
• Cardiac and circulatory diseases (19%)
• Dementia/Alzheimer’s (17%)
• Respiratory diseases (11%)
• Stroke (9%)

Other conditions include end-stage liver and kidney disease, amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) and other degenerative neurological diseases.

Is the patient showing any of these signs of decline?

• A doctor has certified the patient has six months or less to live if the condition/disease follows its normal course
• Curative treatments (medications, chemotherapy, rehab, etc.) are no longer effective or create side effects that prolong suffering, discomfort, and pain
• The patient has decided to stop testing, hospitalizations, and treatments in favor of palliative care
• The patient is increasingly unable to perform the activities of daily living (personal hygiene, dressing, eating, maintaining continence, transferring)
• Over 4–6 months, the patient has experienced any of these:
• Loss of 10% or more of body weight
• More than 3 hospitalizations or emergency room visits
• Presence of other co-morbid conditions
• Declining physical activity
• Declining mental alertness/cognition