Hospice Eligibility Guidelines for Individuals with End-Stage Liver Disease

We understand that navigating the complexities of hospice care can be overwhelming, especially when dealing with end-stage liver disease. This page aims to provide you with a comprehensive guide to the eligibility guidelines for hospice care specifically designed for individuals facing end-stage liver disease.

End-Stage Liver Disease diagnoses may include but are not limited to:

• Liver Failure
• Liver Cancer
• Advanced Liver Disease
• Decompensated Cirrhosis

Disease Specific Guidelines

Patients who meet the following criteria will be deemed to be in the terminal stage of liver disease, with a life expectancy of six months or less if the illness runs its course. These criteria apply to patients with different forms of liver disease who ultimately follow a final common pathway for end-stage disease. The patient should show numbers 1 &2 while number 3 will serve to add supporting documentation.

1. The patient should have prothrombin time that is more than 5 seconds over control, or International Normalized Ratio (INR) >5 AND serum albumin < 2.5gm/dl
2. End-stage liver disease is present and the patient shows at least one of the symptoms below:
   1. Ascites (abdominal fluid accumulation), despite treatment (sodium restriction or use of diuretics) or due to patient non-compliance with treatment regimen
   2. Hepatic encephalopathy (neurological decline), despite treatment (lactulose, protein restriction, or neomycin) or due to patient non-compliance with treatment regimen
   3. Spontaneous bacterial peritonitis
   4. Recurrent variceal bleeding, despite intervention
   5. Hepatorenal syndrome (elevated BUN and creatinine levels with oliguria [small amounts of urine]).
3. Documentation of the following will be supportive but not required to establish hospice eligibility:
   1. Progressive malnutrition
   2. Muscle wasting
   3. Weakness and easy fatigue
   4. Hepatocellular carcinoma
   5. Hepatitis C despite interferon treatment
   6. Hepatitis B positive status

Non-Disease Specific Guidelines

1. Physiologic impairment of functional status demonstrated by a score < 70% using either:
   1. Karnofsky Performance Status (KPS)
   2. Palliative Performance Score (PPS)
2. Dependence on assistance for two or more of the following activities of daily living (ADLs):
   1. Feeding
   2. Bathing
   3. Dressing
   4. Toileting
   5. Ambulation (walking/moving)
   6. Transfer

Co-morbidities

Although not the primary hospice diagnosis, the presence of certain co-morbidities should be considered in determining hospice eligibility, as the severity of these conditions is likely to contribute to a life expectancy of six months or less. These co-morbidities may include:

• Chronic obstructive pulmonary disease
• Congestive heart failure
• Ischemic heart disease
• Dementia
• Renal failure
• Diabetes mellitus
• Liver disease
• Acquired immune deficiency syndrome (AIDS)
• Neurologic disease (CVA, ALS, MS, Parkinson’s)
• Neoplasia

Disclaimer: Please note that the information provided on this page is intended for general guidance purposes only and should not replace professional medical advice. Each individual’s situation is unique, and eligibility for hospice care should be assessed by qualified healthcare professionals.

 

Benefits of Hospice Care for Individuals with End-Stage Liver Disease:

Hospice care offers numerous benefits tailored to the specific needs of individuals with end-stage liver disease. Some of these benefits include:

1. Pain and Symptom Management: Hospice care focuses on alleviating pain and managing distressing symptoms associated with end-stage liver disease.

For those with end-stage liver conditions this can include managing symptoms commonly experienced which may include:

• Shortness of breath
• Abdominal discomfort and bloating
• Cognitive decline
• Loss of appetite
• Itching
• Decreased nutrition and weight loss
• Nausea/vomiting
• Edema/swelling
• Easy bruising and bleeding
• Weakness
• Pain
• Sleep disturbance
• Agitation

The interdisciplinary team, including physicians, nurses, respiratory therapists, social workers, and chaplains, work together to develop a comprehensive plan that addresses the unique needs of each patient.

2. Medication and Equipment Support: Hospice provides medications, oxygen, and other necessary equipment (mobility aides, hospital bed, etc.) related to managing the symptoms that may arise with end-stage liver disease. This ensures that patients have access to the resources they need to maintain comfort and improve their quality of life. All medications and durable medical equipment related to the terminal condition are covered under the hospice benefit.

3. Emotional and Psychosocial Support: Hospice care extends support not only to patients but also to their families and caregivers. Helping a loved one with end-stage liver disease can be challenging. Social workers and counselors are available to provide emotional support, counseling, and resources to cope with the challenges that arise during this difficult time. The nursing team is available to assist in educating and guiding you through providing the best care to your loved one with end-stage liver disease.

4. Skilled Nursing Care: Hospice care includes skilled nursing services provided by specially-trained hospice nurses who have expertise in managing the complexities of end-stage liver disease. These skilled nurses assess and monitor the patient’s condition, provide anticipatory guidance based on disease progression, educate the patient and caregivers, manage medications, provide wound care if needed, and collaborate with other healthcare professionals to ensure comprehensive care.

5. Assistance with Activities of Daily Living (ADLs): Nurse aides, also known as certified nursing assistants (CNAs), are an integral part of the hospice team. They provide hands-on assistance with activities of daily living (ADLs), such as bathing, dressing, grooming, and toileting. For individuals with end-stage liver disease who may experience confusion and cognitive decline, edema and swelling, and other physical limitations due to disease progression, nurse aides help maintain personal hygiene, promote comfort, and preserve dignity.

6. 24/7 Access to Care: Hospice care offers round-the-clock access to the hospice team, providing peace of mind for patients and their families. This availability ensures that assistance is available whenever it is needed, even outside regular office hours.

7. Spiritual and Bereavement Support: Hospice care acknowledges the importance of spiritual and emotional well-being during end-of-life care. Chaplains or spiritual counselors are available to provide spiritual support, and bereavement services are offered to help families cope with grief and loss after the passing of a loved one.

8. Self-guidance: An individual is allowed to receive care in their preferred setting and have input on their care allowing for an increased sense of comfort.

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Not sure if you or a loved one are eligible to receive hospice care?

Contact the Honor Hospice team for an evaluation to determine if hospice is an appropriate care option.