General Referral Criteria (one or more of the following):

Presence of a Serious, Chronic Illness
  • Declining ability to complete activities of daily living
  • Weight loss
  • Multiple hospitalizations
  • Difficult to control physical or emotional symptoms related to serious medical illness
  • Patient, family or physician uncertainty regarding prognosis
  • Patient, family or physician uncertainty regarding goals of care
  • Patient or family requests for futile care
  • DNR order conflicts
  • Use of tube feeding or TPN in cognitively impaired or seriously ill patients
  • Limited social support and a serious illness (e.g., homeless, chronic mental illness)
  • Patient, family or physician request for information regarding hospice appropriateness
  • Patient or family psychological or spiritual distress
Oncology Criteria
  • Metastatic or locally advanced cancer progressing despite systemic treatments with or without weight loss and functional decline;
    • Progressive brain metastases following radiation
    • New spinal cord compression or neoplastic meningitis
    • Malignant hypercalcemia
    • Progressive pleural/peritoneal or pericardial effusions
    • Failure of first – or second-line chemotherapy
    • Multiple painful bone metastases
    • Consideration of interventional pain management procedures
    • Severe prolonged pancytopenia in the setting of an untreatable hematological problem (e.g., relapsed
Emergency Department Criteria
  • Multiple recent prior hospitalizations with same symptoms/problems
  • Long-term-care patient with Do Not Resuscitate (DNR) and/or Comfort Care (CC) orders
  • Patient previously enrolled in a home or residential hospice program
  • Patient/caregiver/physician desires hospice but has not been referred
  • Consideration of ICU admission and or mechanical ventilation in a patient
    • with metastatic cancer and declining function
    • with moderate to severe dementia
    • with one or more chronic diseases and poor functional status at baseline
Intensive Care Unit Criteria
  • Admission from a nursing home in the setting of one or more chronic life-limiting conditions (e.g., dementia)
  • Two or more ICU admissions within the same hospitalization
  • Prolonged or difficult ventilator withdrawal
  • Multi-organ failure
  • Consideration of ventilator withdrawal with expected death
  • Metastatic cancer
  • Anoxic encephalopathy
  • Consideration of patient transfer to a long-term ventilator facility
  • Family distress impairing surrogate decision making



The Joint Commission organization certification ID number: 531243

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