Anyone diagnosed with a terminal condition and with a life expectancy of six months or less is eligible for hospice. The most common diagnoses of hospice patients, the definition of the disease or condition, and indicators that it may be time to consider hospice care are described below:
- Advanced Dementia: Dementia, sometimes referred to as senility, represents a broad range of cognitive (thinking/memory) dysfunction, including but not limited to Alzheimer’s disease. Dementia is defined as a more significant change in a person’s usual mental functioning than would be expected due to aging. Advanced dementia is characterized by difficulty swallowing; inability to speak, dress, or feed oneself; loss of bowel and bladder control; and progressive weight loss.
- AIDS: Acquired immune deficiency syndrome (AIDS) comprises a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV). Although many people these days with HIV infection have a much improved life expectancy, AIDS remains a common illness. As the infection progresses, it affects the immune system and therefore puts the individual at higher risk for diseases such as tuberculosis as well as opportunistic infections like pneumonia and tumors. The most common initial conditions suggesting the possibility that an HIV-infected individual has AIDS are pneumonia, cachexia (weight loss, muscle atrophy, weakness, loss of appetite) in the form of HIV wasting syndrome, and esophageal candidiasis. Another common sign is recurring respiratory tract infections. Indicators that the disease is in a terminal stage include more frequent infections, self-care deficits, ongoing weight loss/weakness, and the ineffectiveness of medications to treat symptoms.
- ALS (Amyotrophic Lateral Sclerosis, or Lou Gehrig’s Disease): This is a somewhat rare but devastating disease that typically manifests in individuals between the ages of 50 and 60. ALS results in the death of the nerve cells in the brain that control voluntary muscles. There’s no cure, and the average life expectancy from the time of onset to death is two to four years. ALS is determined to be in an advanced stage when the patient evidences impaired swallowing/breathing, self-care deficits, muscle wasting and rigidity, and progressive weight loss.
- Cancer (stage IV, untreatable): “Cancer” refers to more than 100 diseases caused by abnormal growth of cells that have the potential to spread to other parts of the body (metastatic disease). Great advances have been made in the treatment of almost all cancers, but because an average of one in two men and one in three women will develop cancer in their lifetime, it remains a common cause of death. A patient with cancer is considered a candidate for hospice when all treatment options have been exhausted, are no longer effective, or none are available, or the patient refuses or wishes to stop treatment.
- Congestive Heart Failure: Congestive heart failure (CHF) describes a condition in which the heart is unable to contract sufficiently to maintain blood flow to meet the body’s needs. Indicators of CHF include shortness of breath (apnea), excessive tiredness, and swelling of the legs. Apnea is typically worse when the patient is lying down and may wake them at night. In advanced CHF, the kidneys cause the body to retain fluid and salt in not only the legs and arms but in organs such as the lungs, which can result in life-threatening congestion in these organs. A patient with CHF may be eligible for hospice care if one or more of the following are present: severe fatigue, dyspnea at rest, chronic fluid buildup, and frequent hospitalizations to treat CHF symptoms.
- Failure to Thrive: In the elderly, “failure to thrive” is characterized by weight loss, decreased appetite, poor nutrition, and inactivity. Patients suffering from impaired physical function (including multiple organ failure), malnutrition, depression, and cognitive impairment are often candidates for hospice care under this diagnosis.
- Respiratory/pulmonary Disease: Respiratory disease includes disorders such as chronic obstructive pulmonary disease (COPD) and emphysema. Both COPD and emphysema are progressive diseases often triggered by environmental factors such as smoking or poor air quality. COPD is characterized by poor, long-term airflow in the lungs that results in shortness of breath and productive cough. Emphysema results when the alveoli (air sacs) in the lungs that promote the transfer of oxygen from the air into the bloodstream are destroyed, resulting in shortness of breath. Advanced respiratory disease is defined as disabling breathing difficulty, poor control of symptoms, dependence on supplemental oxygen, and frequent hospitalizations to treat symptoms of the disease. Individuals with advanced disease are often candidates for hospice.
- Stroke: “Stroke” is a common term for an event referred to as a cerebrovascular accident (CVA). This describes an acute situation in which blood flow to brain cells is interrupted, either because of a clot in the vessel providing blood to those cells (ischemic CVA) or due to a rupture of that blood vessel (hemorrhagic CVA). If a stroke is detected as soon as it occurs and the patient is taken to the emergency room, there’s an excellent chance of recovery. However, a stroke may result in irreversible damage to the brain in which the patient is unable to swallow, walk, or attend to normal daily functions and may become a candidate for hospice care.
The majority of people who receive hospice care have been diagnosed with stage IV cancer, end-stage chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), advanced dementia, or failure to thrive.