Minnesota Hospice wants to make the transition to hospice care easy and stress-free for patients, families, and medical professionals.  We understand determining hospice eligibility can be challenging.  Our goal is to provide you with the clinical information you need regarding eligibility, along with a simple referral process to ensure the best possible outcomes for your patients with advanced life-limiting illnesses and their loved ones.

Referral Process

Fax

Please send the following information to our secure Intake Fax Line at 651-796-9005.

• Face Sheet
• Signed Physician Order, stating “Ok to eval and treat for hospice”

Call

Call Minnesota Hospice which is answered 24/7 at 952-898-1022.

Emergency Assistance

If an emergency admission is required, please fax the following information and call us which is answered 24/7 at 952-898-1022.

• Patient full legal name
• Patient date of birth
• Patient address
• Patient social security number
• Patient Medicare number
• Diagnoses
• Signed Physician Order, stating “Ok to eval and treat for hospice”

General Clinical Guidelines

Hospice-appropriate individuals may exhibit some or all the general indicators for disease progression. If 3 or more of these indicators are present, it may be time to refer to hospice.

Clinical Status

• Recurrent or intractable serious infections (i.e. pneumonia, sepsis or pyelonephritis)
• Significant weight loss of at least 10% body weight in the past 6 months (Learn about Body Mass Index here)
  • Weight loss cannot be due to reversible causes such as depression or diuretic use
  • A documented decrease in anthropomorphic measurements (mid-arm circumference or abdominal girth)
  • Observation of ill-fitting clothes, decreased skin turgor, increasing skin folds or other observation of weight loss without documented weight
• Decreasing serum albumin or cholesterol
• Dysphagia with recurring aspiration and/or inadequate oral intake documented by a decrease in food consumption

Symptoms

• Dyspnea with an increase in respiratory rate
• Intractable cough
• Nausea or vomiting poorly responsive to treatment
• Intractable diarrhea
• Pain requiring more than brief increases in major analgesics

Signs

• Decline in systolic blood pressure to below 90 or progressive postural hypotension
• Ascites
• Venous, arterial or lymphatic obstruction due to local progression or metastatic disease
• Edema
• Pleural / pericardial effusion
• Weakness
• Changes in levels of consciousness

Laboratory

• Increasing pCO2 or decreasing pO2 or SaO2
• Increasing calcium, creatinine or liver function studies
• Increasing tumor markers (i.e., PSA or CEA)
• Progressively decreasing or increasing serum sodium or increasing serum potassium

Additional Considerations

• Frequent hospitalizations, ER visits, or physician visits related to primary hospice diagnosis within the past 6 months
• A decline in Karnofsky Performance Status (KPS) or Palliative Performance Score (PPS) due to disease progression
• Progressive decline in Functional Assessment Staging (FAST) for dementia of at least 7A
• Dependence on assistance for two or more activities of daily living (ambulation, continence, transfer, dressing, feeding, and/or bathing)
• Progressive stage 3-4 pressure ulcers despite optimal care
• Co-morbidities—although not the primary hospice diagnosis, but the severity of which is likely to contribute to a life expectancy of 6 months or less
  • Chronic obstructive pulmonary disease (COPD)
  • Congestive heart failure
  • Ischemic heart disease
  • Diabetes mellitus
  • Neurological disease (Parkinson’s, CVA, ALS, MS)
  • Renal failure
  • Liver disease
  • Neoplasia
  • Dementia
  • Acquired Immune Deficiency Syndrome / HIV
  • Refractory severe autoimmune disease (i.e. Lupus or Rheumatoid Arthritis)

Disease-Specific Guidelines

• Cancer Indicators
• Alzheimer’s Disease and Dementia-Related Disorders Indicators
• Cardiac Disease Indicators
• HIV Indicators
• Liver Disease Indicators
• Neurological Disease Indicators (ALS/MS/Palsy/Parkinson’s)
• Pulmonary Disease Indicators
• Renal Disease Indicators (Chronic)
• Stroke/Coma Indicators