1. SECTION 2: DISEASE SPECIFIC GUIDELINES
These guidelines should be used as a starting point if the patient has one of the following
diseases:
(Click on each disease to learn more)
Cancer
ALS
Alzheimer’s Disease
Heart Disease
HIV /AIDS
Liver Disease
Lung Disease
Kidney Disease
Stroke
Coma
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2. ABOUT THIS SECTION
If a patient has one of the disease we
just listed, he or she needs to meet the
guidelines in Section 2 AND the
guidelines for his or her specific disease
in Section 3 in order to be eligible for
hospice care.
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3. A. CAN THE PATIENT PERFORM NORMAL DAILY TASKS WITHOUT HELP?
Doctors measure a patient’s ability to perform normal daily tasks using a scale
called the Karnofsky Performance Status Scale . Another type of scale that could
be used is the Palliative Performance Scale. Both of these scales go from 100% to
0%. 100% means the patient is able to perform normal daily tasks without any
help. 0% means the patient has died.
If the patient scores less than 70% on either the Karnofsky Performance
Status Scale or the Palliative Performance scale, they meet this guideline for hospice
eligibility.
Does the patient meet this guideline?
YES NO
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4. B. DOES THE PATIENT NEED HELP PERFORMING THESE TASKS?
YES
Walking
YES
Going to the bathroom
Moving from one position to YES
another
YES
Getting dressed
YES
Eating
Taking a bath or shower YES
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5. C. OTHER DISEASES
The next set of slides will describe several diseases
that the patient might have. These diseases would
be in addition to the disease that causes the patient
the most trouble. Additional diseases, called co-
morbidities, can limit how long a patient will live.
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6. COPD
COPD stands for Chronic Obstructive Pulmonary Disease.
COPD is a group of lung diseases in which something (like
an inflamed esophagus, mucus, or something else) blocks
the patient’s airway and makes it difficult for them to
breathe. COPD is most common in heavy smokers.
Does the patient have COPD?
YES NO
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7. CONGESTIVE HEART FAILURE
Congestive heart failure happens when the
patient’s heart has become weak and cannot
pump enough blood to the rest of the body. This
causes the patient’s kidneys to make the body
hold on to more water, making the body
“congested.”
Does the patient have Congestive Heart Failure?
YES NO
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8. ISCHEMIC HEART DISEASE
Ischemia means “not enough blood.” In Ischemic heart
disease, the heart itself is not getting enough blood to
work properly. This is usually because the patient’s
arteries are blocked by cholesterol or blood clots, but
other problems could keep blood from getting to the
heart too. Symptoms of ischemic heart disease are
chest pain and weakness.
Does the patient have Ischemic Heart Disease?
YES NO
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9. DIABETES
Diabetes, also known as diabetes mellitus, is a disease in
which the patient’s blood sugar is too high. This can be
because the patient’s pancreas doesn’t produce enough
insulin (the chemical that regulates blood sugar) or
because the patient’s body doesn’t respond to the insulin
that the pancreas makes. Symptoms of diabetes include
having to urinate more often and being hungry and
thirsty very frequently.
Does the patient have diabetes?
YES NO
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10. PARKINSON’S DISEASE
Parkinson’s disease is a brain and nerve disease
that causes shaking and inability to control
movement. It happens when the brain cells that
produce dopamine die off. Dopamine is the
chemical that allows nerves to control how muscles
move.
Does the patient have Parkinson’s disease?
YES NO
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11. MULTIPLE SCLEROSIS
Multiple sclerosis is a disease that happens when the patient’s
immune system attacks her nerves and destroys the protective
covering on the nerves. Multiple sclerosis causes the sufferer to
have trouble controlling the part of the body that is being
attacked. For instance, if the leg muscles are attacked, the
patient would have difficulty walking. If the bladder is
attacked, the patient would lose control of their bladder.
Does the patient have multiple sclerosis?
YES NO
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12. LOU GEHRIG’S DISEASE
Lou Gehrig’s disease is a common name for
amyotrophic lateral sclerosis, or ALS. ALS
happens when the patient’s nerve cells die over
time. This causes the patient to slowly lose control
of their muscles and become paralyzed.
Does the patient have Lou Gehrig’s Disease?
YES NO
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13. STROKE
A stroke happens when part of the brain doesn’t
get enough blood and the brain cells die. Stroke
symptoms depend on what part of the brain the
stroke happens in, but can include loss of muscle
control or paralysis in the parts of the body
controlled by the part of the brain that lost blood.
Has the patient had a stroke?
YES NO
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14. KIDNEY FAILURE
Kidney failure is when the kidneys can't filter
waste out of the patient's blood well enough.
The build up of waste chemicals in the patient's
blood causes damage to other parts of the
body as the kidney failure gets worse.
Does the patient have kidney failure?
YES NO
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15. LIVER DISEASE
In this case, liver disease could be any
disease that mostly affects the liver and
could limit the patient’s life to six months
or less.
Does the patient have liver disease?
YES NO
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16. NEOPLASIA
Neoplasia is the growth of tumors
throughout the body, or the growth of
abnormal cells in the patient's body.
Does the patient have neoplasia?
YES NO
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17. DEMENTIA
Dementia is when the patient loses the use of parts of
their brain. This causes the loss of the ability to
think, reason, and remember. Patients with dementia may
also have trouble speaking and understanding what is
being said to them. There are several diseases that can
cause dementia, including Alzheimer's disease.
Does the patient have dementia?
YES NO
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18. HIV/AIDS
HIV stands for human immunodeficiency virus. HIV is
a virus associated with acquired immunodeficiency
syndrome (AIDS). HIV/AIDS weakens the patient’s
immune system so that the patient’s body can’t fight
off other illnesses. AIDS is the final stage of an HIV
infection.
Does the patient have HIV/AIDS?
YES NO
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19. LUPUS
Lupus is a disease in which the body attacks its
own healthy tissue, including skin, joints and
organs. The cause is not known. Symptoms include
chronic pain and swelling in the affected areas.
Does the patient have lupus?
YES NO
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20. RHEUMATOID ARTHRITIS
Rheumatoid arthritis is the long term
inflammation (swelling and pain) of joints. This
happens when the body attacks its own tissues
near the joints.
Does the patient have rheumatoid arthritis?
YES NO
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21. Yes to Stroke
Next  On your worksheet, write:
“The patient also has had a stroke”
 When ready, select, “Next”

22. Yes to help with transfer
Back  On your worksheet, write:
“The patient needs help transferring from
one spot to another.”
 Select “Back” when ready

23. Yes to Kidney Failure
Next  On your worksheet, write:
“The patient also has kidney failure”
 When ready, select, “Next”

24. Yes to help getting dressed
Back  On your worksheet, write:
“The patient needs help getting dressed.”
 When ready, select “back”

25. Yes to Dementia
Next  On your worksheet, write:
“The patient also has dementia”
 When ready, select, “Next”

26. Yes to Neoplasia
Next  On your worksheet, write:
“The patient also has neoplasia”
 When ready, select, “Next”

27. Yes to HIV/AIDS
Next  On your worksheet, write:
“The patient also has HIV/AIDS”
 When ready, select, “Next”

28. Yes to Liver Disease
Next  On your worksheet, write:
“The patient also has liver disease”
 When ready, select, “Next”

29. Yes to Lupus
Next  On your worksheet, write:
“The patient also has lupus”
 When ready, select, “Next”

30. Yes to help bathing
Back  On your worksheet, write:
“The patient needs help bathing.”
 Select “Back” when ready

31. Yes to rheumatoid arthritis
Next  On your worksheet, write:
“The patient also has rheumatoid
arthritis.”
 When ready, select, “Next”

32. Yes to trouble eating
Back  On your worksheet, write:
“The patient needs help eating.”
 Select “Back” when ready

33. Yes to help with bathroom
Back  On your worksheet, write:
“The patient needs help going to the
bathroom.”
 Select “Back” when ready

34. Yes to Trouble Walking
Back  On your worksheet, write:
“The patient needs help walking”
 Select “back” when ready.

35. Palliative Performance Scale
Back  The Palliative Performance Scale (PPS)
See an is similar to the Karnofsky Performance
Example Status Scale but it is used for patients
Learn More receiving care to relieve pain (palliative
care).

36. Karnofsky Performance Status Scale
Back  The Karnofsky Performance Status Scale
See an (KPS) is a questionnaire that doctors use
Example to figure out how much the patient’s
Learn More disease keeps them from performing
daily tasks.

37. Yes on Karnofsky Scale
Next On your worksheet, write
“The patient scored less than 40% on the
Karnofsky Performance Scale.”
 Choose “Next” when ready

38. Cancer
Back  Cancer is a group of diseases in which
Learn More
diseased cells grow out of control in the
patient’s body. Cancer comes in a lot of
different forms and can affect a
specific part of the body or lots of
different parts of the body. It can start
in one part of the body and spread to
other parts. Different types of cancer
cause different symptoms, and are
treated differently.

39. ALS
Back  ALS stands for Amyotrophic Lateral
Learn More Sclerosis. It is also known as Lou
Gehrig’s disease, after a famous
baseball player who suffered from it.
ALS causes nerve cells to die off so that
they can’t control muscle movement any
more. This causes the patient to become
paralyzed overtime.

40. Alzheimer’s Disease
Back  Alzheimer’s disease is a form of
Learn More dementia that gets worse over time.
Dementia is a condition in which the
brain loses its ability to
think, reason, and remember things.
Scientists don’t really know what causes
Alzheimer’s disease yet.

41. Heart Disease
Back  In this case, heart disease could be any
Learn More kind of disease that mostly affects the
patient’s heart and could limit the
patient’s life to six months or less.

42. HIV/AIDS
Back  HIV stands for human immunodeficiency
Learn More virus. HIV is a virus associated with
acquired immunodeficiency syndrome
(AIDS). HIV/AIDS weakens the patient’s
immune system so that the patient’s
body can’t fight off other illnesses.

43. Liver Disease
Back  In this case, liver disease could be any
Learn More disease that mostly affects the liver and
could limit the patient’s life to six months
or less.

44. Lung Disease
Back  Diseases that affect the lungs are also
Learn More called pulmonary diseases. In this
case, lung disease could be any disease
that mostly affects the lungs and could
limit the patient’s life to six months or
less.

45. Kidney Disease
Back  Diseases that affect the kidneys are
Learn More also called renal diseases. In this
case, kidney disease could be any
disease that mostly affects the kidneys
and could limit the patient’s life to six
months or less.

46. Stroke
Back  A stroke happens when blood stops
Learn More flowing to part of the patient’s brain.
This causes brain cells in that part of the
brain to die. Depending on where in the
brain the cells died, patients can lose
their bodies’ abilities to perform
different functions.

47. Coma
Back  A coma is when a patient has been
Learn More unconscious for more than six
hours, can’t be awakened, doesn’t
respond to things that should case
pain, doesn’t have a normal sleep cycle
and can’t feel, speak, hear or move.

48. Yes to COPD
Next  On your worksheet, write:
“The patient also has COPD”
 Select “Next” when ready.

49. Yes to Congestive Heart Failure
Next  On your worksheet, write,
“The patient also has congestive heart
failure.”
 When ready, select “Next”

50. Yes to Ischemic Heart Disease
Next  On your worksheet, write:
“The patient also has Ischemic Heart
Disease”
 When ready, select “Next”

51. Yes to Diabetes
Next  On your worksheet, write,
“The patient also has diabetes”
 When ready, select “Next”

52. Yes to Parkinson’s Disease
Next  On your worksheet, write:
“The patient also has Parkinson’s disease”
 When ready, select, “Next”

53. Yes to Multiple Sclerosis
Next  On your worksheet, write:
“The patient also has Multiple Sclerosis”
 When ready, select, “Next”

54. Yes to Lou Gehrig’s Disease
Next  On your worksheet, write:
“The patient also has Lou Gehrig’s
disease”
 When ready, select, “Next”

55. NEXT STEPS
This is the end of Section 2. In order for the patient to be considered eligible for hospice
care you must also complete the section 3 component that matches the patient’s disease.
You may either go on to Section 3 now, by selecting the patient’s disease from the list
below, or exit and come back later by selecting “EXIT”. You may also restart Section 2 by
selecting “HOME”
Section 3 Components (Select patient’s disease)
Cancer Liver Disease
ALS Lung Disease
Alzheimer’s Disease Kidney Disease
Heart Disease Stroke
HIV /AIDS Coma
HOME EXIT