To qualify for hospice, patients must have:
- Prothrombin time prolonged more than 5 seconds over control, or International Normalized Ratio > 1.5
- Serum albumin < 2.5 gm/dl
And exhibit at least one of the following:
- Ascites, refractory to treatment or patient non-compliant
- Spontaneous bacterial peritonitis
- Hepatorenal syndrome
- Hepatic encephalopathy, refractory to treatment or patient non-compliance
- Recurrent variceal bleeding, despite intensive therapy
The following factors support a hospital referral:
- Progressive malnutrition
- Muscle wasting with reduced strength and endurance
- Continued active alcoholism (>80 gm ethanol/day)
- Hepatocellular carcinoma
- Hepatitis B positivity
- Hepatitis C refractory to interferon treatment
Patients awaiting liver transplant who otherwise fit the above criteria may be certified for the Medicare hospice benefit, but if a donor organ is procured, the patient must be discharged from hospice.