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A hospice aide enjoying the outdoor weather during sunset with her patient.
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Hospice Admission


Heart Disease

LCD Guidelines

Heart Disease

(1 & 2 are required, 3 will act as supporting documentation.)

1. At the time of certification/ recertification for hospice, the patient is or already has been optimally treated for heart disease or is not a candidate for a surgical procedure or has declined a procedure. (Optimally treated = patients not on vasodilators have medical reason for refusing drugs, e.g. hypotension or renal disease.)
2. The patient is classified as New York Heart Association (NYHA) Class IV & may have significant symptoms of heart failure or angina at rest. (Class IV patients w/ heart disease have an inability to carry on any physical activity without discomfort. Symptoms of heart failure or of the angina syndrome may be present even at rest. If any physical activity is undertaken discomfort is increased.) Significant congestive heart failure may be documented by an ejection fraction of ≤20% but is not required if not already available.
3. The following factors are not required for hospice eligibility but act as supporting documentation:
A. Treatment resistant symptomatic supraventricular or ventricular arrhythmias
B. History of cardiac arrest or resuscitation
C. History of unexplained syncope
D. Brain embolism of cardiac origin
E. Concomitant HIV disease

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Comparative Data

Change in Activity - Patient was going to activity daily now stays in room, Was able to walk down the hall now unable to walk more than 5 feet
Change in Breathing - Patient is now using purse lip breathing, labored breathing
Increase in SOB - Patient was able to walk down the hallway without oxygen, Patient is now using oxygen & is only able to ambulate 15 feet without resting
Pain - Increase in pain medications, chest pain noted with activity
Anxiety - Patient gets very anxious when short of breath, Patient states “I get very nervous when I can’t breathe”
Edema - Previously no edema, now edema is present in feet & ankles
Change in weight - Patient has gained 5lbs in 5 days related to edema
Depression - Patient is withdrawn, does not engage in activity
Intake - Patient complains of feeling full but is only eating 25% of meal, Patient was eating 100% of meal & now only eating 50%
Change in ADL’s - Patient was previously stand by assist w/ bathing; now is a 1 person assist
Medication changes - We have changed Lasix every week


Kidney Failure
Syncopal Episodes


Weight Gain


Pulmonary Fibrosis

Available 24/7

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