Reliance Hospice & Palliative Care | Why Reliance?
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Why Reliance?

Hospice or Palliative:

Hospice care is focused on controlling pain and managing symptoms, rather than attempting to cure. Palliative care is for patients who are not yet eligible for hospice care but have serious progressive illness or conditions causing symptoms that are difficult to manage.

Who Pays for Hospice?

Reliance Hospice and Palliative Care is Medicare/Medi-Cal certified and accepts Medicare, Medi-Cal, private insurances, and other forms of reimbursement for services.

Admission Criteria:

Two or more items in any category should generate a hospice referral.

 

Please call our Referral Center at 888-287-1255 or fill out our secure online referral form for healthcare professionals.

 

General Guidelines
  • Life-limiting condition
  • Patient/family focus on symptom relief rather than cure
  • Progression of disease(s)
  • Evidence of weight loss; serum albumin < 2.5g/dl
  • Symptoms & signs that paint a picture of decline
  • Karnofsky or Palliative Performance Scale score < 50%
  • Dependence in at least 2 ADLs
  • Need for frequent hospitalization, office or ER visits
  • Progressive/unhealing stage III or IV pressure ulcers
Cancer
  • Clinical findings of malignancy with widespread, aggressive or progressive disease as evidenced by increasing symptoms, worsening lab values and/or evidence of metastatic disease
  • Impaired performance on Palliative Performance Scale of <70%
  • Refuses further curative therapy or continues to decline despite definitive therapy. Decline evidenced by:
    • Hypercalcemia > or = 12
    • Cachexia or weight loss of 5% in the preceding 3 months
    • Recurrent disease after surgery/radiation/chemotherapy
    • Refusal to pursue additional curative or prolonging cancer treatment
    • Signs and symptoms of adcanced diesease (nausea, anemia, malignant ascites or pleural effusion, etc.)
Pulmonary Disease
  • Severe chronic lung disease
    • Disabling dyspnea at rest, poorly responsive to bronchodilators
    • FEV1 after bronchodilator < 30%
  • Progression of end-stage pulmonary disease
    • Recurrent pulmonary infections
  • Hypoxemia at rest, on room air: pO2 < 55mmHg – or O2 sat < 88%
  • Right heart failure secondary to pulmonary disease
  • Unintentional progressive weight loss >10%
  • Persistent resting tachycardia
Stroke and Coma
  • Karnofsky Performance < 40%
  • Inability to maintain nutrition/hydration
    • Weight loss > 10%, serum albumin < 2.5 gm/dl, pulmonary
  • aspiration, severe dysphagia
  • Coma with any 3 of the following on day 3 of coma
    • Abnormal brain stem response
    • Absent verbal response
    • Absent withdrawal response to pain
    • Serum creatinine > 1.5 mg/dl
Cardiac Disease
  • Symptomatic despite optimal treatment with diuretics and vasodilators
  • Recurrent CHF
    • Ejection fraction < 20%
  • New York Heart Association Class IV
  • Supporting factors
    • Arrhythmias are resistant to treatment
    • History of cardiac arrest or resuscitation
    • History of unexplained syncope
    • Cardiogenic embolic disease (e.g., CVA)
Renal Disease – Acute Renal Failure
  • Patient is not seeking dialysis or transplant
    • Creatinine > 8mg/dl (> 6mg/dl for diabetics)
  • GFR < 10ml/min
    • Creatinine clearance <10cc/min (<15cc/min for diabetics)
  • Co-morbid conditions
Renal Disease – Chronic Renal Failure
  • Patient is not seeking dialysis or transplant
  • Creatinine clearance <10cc/min (<15cc/min for diabetics)
    • Creatinine > 8mg/dl (> 6mg/dl for diabetics); GFR < 10ml/min
  • Symptoms: uremia; oliguria; confusion; nausea; vomiting; pruritus; restlessness; hyperkalemia > 7.0, not responsive to treatment; intractable fluid overload, not responsive to treatment
Liver Disease
  • PTT > 5 seconds over control
  • Serum Albumin < 2.5gm/dl
  • End-stage liver disease
    • Ascites refractory to treatment
    • Spontaneous bacterial peritonitis
    • Hepatorenal syndrome
    • Hepatic encephalopathy, refractory to treatment
  • Supportive factors
    • Progressive malnutrition
    • Continued alcoholism
    • Hepatocellular carcinoma
Dementia
  • Functional Assessment score = 7
    • Unable to ambulate without assist
    • Unable to dress or bathe without assist
    • Urinary and fecal incontinence, intermittent or constant
    • No consistently meaningful verbal communication
  • Complications such as aspiration pneumonia, UTI, septicemia, recurrent fevers
  • Decubitus ulcers stage 3 or 4
  • Weight loss of >10% over last six months
ALS
  • Critically impaired respiratory function
    • Dyspnea at rest
    • Use of accessory muscles
    • Respiratory rate > 20
    • Reduced speech / vocal volume
    • Unexplained headaches, anxiety or nausea
  • Severe nutritional insufficiency
    • Progressive weight loss of at least 5% of body weight
  • With or without gastrostomy tube insertion
HIV
  • CD4 count < 25 cells/mcl or persistent viral load >100,000 copies/ml
  • Decreased performance status
  • Supporting factors
    • Chronic persistent diarrhea
    • Persistent serum albumin < 2.5
    • Concomitant substance abuse
    • Age > 50
    • Advanced AIDS dementia complex
    • CHF or advanced liver disease

Source: Current CMS and NHPCO guidelines