The patient has critical nutritional impairment evidenced by:

  • Oral intake of nutrients and fluids insufficient to sustain life
  • Continuing weight loss

Rapid disease progression or complications in the preceding 12 months as evidenced by:

  • Progression from independent ambulation to wheelchair or bed bound status
  • Progression from normal to barely intelligible or unintelligible speech
  • Progression from normal to pureed diet
  • Progression from independent in most or all activities of daily living (ADLs) to needing major assistance by caretaker in all ADLs

Life-threatening complications in the preceding 12 months as evidenced by one or more of the following:

  • Critically impaired breathing capacity
  • Dyspnea at rest
  • The requirement of supplemental oxygen at rest
  • The patient declines artificial ventilation
  • Recurrent aspiration pneumonia (with or without tube feedings)
  • Upper urinary tract infection (pyelonephritis)
  • Sepsis
  • Recurrent fever after antibiotic therapy
  • Stage 3 or 4 decubitus ulcers

A physician may determine that a patient has a life expectancy of six months or less even if the above findings are not present. Co-morbidities also support eligibility for hospice care.