HOSPICE
Cascade Health Hospice Information for Referring Providers
Working with Cascade Health Hospice means you can be confident your patients will continue to receive exceptional, compassionate health care after the benefits of curative treatment have been exhausted. For patients facing a terminal prognosis, hospice care has long been recognized for its ability to improve physical comfort, psychosocial health and quality of life — and research shows it can even increase life expectancy.
If you would like help determining if hospice is right for your patient, call our medical director, Kathleen Cordes, M.D., for an eligibility consultation now. We’re available 24/7.
Why Cascade Health for Hospice
Founded in our community by our community, Cascade Health Hospice has been serving the Eugene and Springfield area since 1984. We are the only hospice in Lane County that offers general inpatient (GIP) care at our Pete Moore Hospice House.
Our holistic, patient-centered approach results in high family satisfaction with care, as evidenced by our excellent Care Compare scores.
Cascade Health Hospice Services Include:
✅ 24/7 intake for a seamless care transition.
✅ Expert medical care, including pain and symptom management.
✅ Culturally sensitive, whole-person care tailored to every patient.
✅ 24/7 patient access to a hospice nurse, including weekends and holidays.
✅ All medications and medical equipment, including delivery, set up and training.
✅ Visits by a medical social worker to help patients and families navigate end-of-life planning, access resources, and manage stress.
✅ Patient and family access to a chaplain and spiritual counseling.
✅ Bereavement care for patients on hospice and their families , and for up to 13 months for surviving family members.
✅ Personal care visits by certified nursing assistants.
✅ Access to respite care and GIP visits to Pete Moore Hospice House as needed.
✅ Additional support for veterans as part of the We Honor Veterans program.
Levels of Care
Cascade Health offers four types of hospice care depending on your patient’s needs.
Hospice Care at Home
Most people prefer to be at home through the end of their lives, and standard home care makes this possible for most Cascade Health patients.
Medicare/Insurance coverage: Home care is 100% covered by Medicare and most private insurance companies.
Duration of care: 6 months of care that can be renewed based on continued eligibility.
Respite Care at Pete Moore Hospice House
Cascade Health’s Pete Moore Hospice House is the only inpatient hospice facility in Lane County and allows us to offer unpaid caregivers time away to regenerate while knowing their loved ones are cared for and safe in a comfortable environment.
Medicare/Insurance coverage: Respite care is covered in full by Medicare and most private insurance companies.
Covered stay: Up to 5 days every 6 months.
Inpatient Care at Pete Moore Hospice House
General Inpatient Care (GIP) is the most medically intensive level of care and is available when symptoms cannot be managed well at home. Eligibility for GIP care is based on specific Medicare criteria and is usually short-term.
Medicare/Insurance coverage: GIP care is fully covered by Medicare and most private insurance companies.
Covered stay: As needed.
Typical duration of stay: 5 days or fewer.
Pete Moore Hospice House Residential Care
Residential care at Pete Moore Hospice House provides all standard home care services as well as room and board.
Medicare/Insurance coverage: The medical portion of residential care is covered by Medicare and most private insurance companies. The patient/family is responsible for daily room and board charges of $595.
Covered stay: At will while eligible for hospice.
A Cascade Health Hospice intake specialist can help you determine if and at which level your patient is eligible for hospice care and discuss options and potential costs with your patient and their family.
When to Refer Patients to Hospice
Deciding when to refer a patient to hospice can be a difficult decision. It can be hard to estimate how long someone has to live, and as providers, we all want the best for our patients.
If your patient has a life-limiting condition and is having a difficult time maintaining a good quality of life, we encourage you to consider the clinical guidelines for hospice referral and call us as early in the process as possible.
Clinical Hospice Eligibility Guidelines
Baseline Guidelines
The following are baseline guidelines you should consider in combination with the disease-specific guidelines below. Patients who only meet these baseline guidelines are not eligible for hospice.
Karnofsky Performance Scale (KPS) or Palliative Performance Scale (PPS) <70%. (HIV, stroke and coma require a lower qualifying score).
Dependence or assistance with 2 or more Activities of Daily Living (ADL): ambulation, continence, transfer, dressing, feeding or bathing.
Comorbidities (not the primary hospice diagnosis) to be considered and lend supporting documentation of eligibility: COPD; CHF; ischemic heart disease; DM; neurologic disease including CVA, ALS, MS, Parkinson’s; renal failure; liver disease; neoplasia; AIDS; dementia; AIDS/HIV; refractory severe autoimmune disease including lupus or rheumatoid arthritis.
Disease-Specific-Guidelines
-
Worsening of clinical status as evidenced by:
Recurrent or intractable serious infections including pneumonia, sepsis, pyelonephritis.
Body weight loss of 10% or more in last 6 months, not due to reversible causes.
Decreasing serum albumin or cholesterol.
Dysphagia causing recurrent aspiration and/or inadequate oral intake documented by decreasing food portion consumption.
Worsening symptoms including dyspnea w/ increasing respiratory rate; intractable cough, nausea/vomiting poorly responsive to treatment; intractable diarrhea; pain requiring frequent increases in medication.
Signs indicating worsening clinical status:
Decline in SBP <90 or progressive hypotension; ascites; venous, arterial or lymphatic obstruction due to metastasis or disease progression; edema; pleural/pericardial effusion; weakness; change in level of consciousness.
Labs indicating worsening clinical status (lab testing is not required, but if available, they do lend supporting documentation for hospice eligibility).
Increasing pCO2 or decreasing pO2 or decreasing SaO2; increasing calcium, creatinine or liver function studies; increasing tumor markers (CEA or PSA); progressively increasing or decreasing serum sodium or increasing serum potassium.
Decline in PPS or KPS value.
Decline in FAST score.
Progressive dependence of ADL’s.
Progressive stage 3-4 pressure ulcers, despite optimal wound care.
Increased ED visits, hospitalizations or MD visits related to hospice primary diagnosis prior to the election of the hospice benefit.
-
Disease with metastasis at presentation or
Progression from an earlier stage of disease to metastatic disease with a continued decline despite therapy or patient declines further disease treatments.
Cancers with poor prognoses (small cell lung cancer, brain cancer and pancreatic cancer) may be hospice eligible without meeting other criteria.
-
Disabling dyspnea at rest.*
Poor or unresponsiveness to bronchodilators causing a decrease in functional capacity (bed to chair existence, cough, and fatigue).
Documented FEV1 less than 30% (this is objective evidence but not required).
Progression of end stage pulmonary disease as evidenced by increasing ED visits or hospitalizations for pulmonary infections and/or respiratory failure.
pO2< or = to 55mgHg; SaO2 < or = to 88%; PCO2 > or = to 50mmHg.*
Right Heart Failure due to pulmonary disease, not due to left heart disease or valvulopathy.
Unintentional weight loss of >10% body weight over the last 6 months.
Resting tachycardia >100/min.
-
Patient is or has been optimally treated (not on vasodilators) for heart disease OR are not candidates for surgical procedures OR they decline those procedures.*
NYHA class IV. Ejection fraction of <20%. Unable to carry on any physical activities and symptoms are present at rest physical activities increase physical discomfort.*
Symptomatic supraventricular or ventricular arrhythmias resistant to treatment, history of cardiac arrest, resuscitation or unexplained syncope.
-
Prothrombin time (PTT) >5 seconds; International Normalized Ratio (INR) >1.5 AND Serum Albumin <2.5gm/dl.*
Ascites, and/or hepatic encephalopathy refractory to treatment; bacterial peritonitis- spontaneous; elevated creatinine and BUN w/oliguria <400mL/day and urine sodium concentration <10meq/l); recurrent variceal bleeding; hepatic encephalopathy.*
Muscle wasting w/ reduced strength and endurance; progressive malnutrition; continued active alcoholism; hepatocellular carcinoma; Hepatitis B positive; Hepatitis C refractory to interferon treatment.
-
Should show all of the following:
FAST Stage 7 or higher.
Unable to ambulate, dress, and bathe without assistance.
Incontinent of bowel and bladder, intermittent or constant.
No consistent meaningful verbal communication; ability to speak limited to 6 or fewer intelligible words.
Should have had one of the following within the past 12 months:
Aspiration pneumonia.
Pyelonephritis.
Septicemia.
Multiple stage 3-4 decubitus ulcers.
Fever, recurrent after antibiotics.
Inability to maintain sufficient fluid and calorie intake with 10% weight loss during the previous 6 months or serum albumin <2.5gm/dl.
-
KPS or PPS value <40%.
Unable to maintain hydration and caloric intake with one of the following: weight loss of >10% in last 6 months or >7.5% in last 3 months; serum albumin <2.5gm/dl; current history of pulmonary aspiration (unresponsive to speech therapy); calorie counts that document inadequate caloric/fluid intake; dysphagia that prevents adequate food/fluids necessary to sustain life and patient not receiving artificial hydration/nutrition.
-
Prothrombin time (PTT) >5 seconds; International Normalized Ratio (INR) >1.5 AND Serum Albumin <2.5gm/dl.*
Ascites, and/or hepatic encephalopathy refractory to treatment; bacterial peritonitis- spontaneous; elevated creatinine and BUN w/oliguria <400mL/day and urine sodium concentration <10meq/l); recurrent variceal bleeding; hepatic encephalopathy.*
Muscle wasting w/ reduced strength and endurance; Progressive malnutrition; continued active alcoholism; hepatocellular carcinoma; Hepatitis B positive; Hepatitis C refractory to interferon treatment.
-
Acute (number 1 AND either 2, 3 or 4 should be present; number 5 lends supporting documentation):
Dialysis or renal transplant not currently pursued, or patient is discontinuing dialysis.
Creatinine clearance <10cc/min (<15 for diabetics); or <15cc/min (<20cc for diabetics) with comorbidity of CHF.
Serum creatinine >8.0mg/dl (>6.0 for diabetics).
Estimated glomerular filtration rate (GFR) <10ml/min.
Conditions that lend supporting documentation to support hospice eligibility include mechanical ventilation; malignancy in another organ system; chronic lung disease; advanced cardiac or liver disease; AIDS, immunosuppression; albumin <3.5 gm/dl; platelet count <25,000; disseminated intravascular coagulation; GI bleed.
Chronic: (number 1 AND either 2, 3 OR 4 should be present, number 5 lends supporting documentation):
Dialysis or renal transplant not currently pursued, or patient is discontinuing dialysis.
Creatinine clearance <10cc/min (<15 for diabetics) or <15cc/min (<20 for diabetics) with comorbidity of CHF.
Serum creatinine >8.0mg/dl (>6.0 for diabetics).
Signs and symptoms of renal failure, including uremia; oliguria (<400cc/24 hr.); intractable hyperkalemia (>7.0) not responsive to treatment; intractable fluid overload, not responsive to treatment; uremic pericarditis; hepatorenal syndrome; intractable fluid overload, not responsive to treatment.
Estimated GFR <10ml/min. lends supporting documentation of hospice eligibility.
-
CD4+ count <25cells/mcl or persistent viral load >100,000 copies/ml (2 or more assays at least 1 month apart), PLUS 1 of the following: CNS lymphoma; untreated or persistent wasting (loss of at least 10% lean body mass), despite treatment; MAC bacteremia-untreated, unresponsive to, or treatment refused; progressive multifocal leukoencephalopathy; systemic lymphoma w/advanced HIV disease and partial response to chemotherapy; Visceral Kaposi’s sarcoma unresponsive to therapy; renal failure in the absence of dialysis; cryptosporidium infection; toxoplasmosis, unresponsive to therapy.*
KPS value of 50% or less.*
Chronic persistent diarrhea > 1 year; persistent albumin <2.5gm/dl; active substance abuse; >50 years of age; advanced AIDS dementia complex; toxoplasmosis; CHF, symptomatic at rest; advanced liver disease; absence of or resistance to effective antiretroviral, chemotherapeutic and prophylactic drug therapy related to HIV disease.
-
It is important to obtain a history of the rate of progression so that an accurate prediction of prognosis can be made. It is key to consider ability to breathe and ability to swallow. To meet hospice criteria, the patient must exhibit:
Vital capacity (VC) <40% of predicted AND with two or more of the following: Dyspnea at rest; orthopnea; paradoxical abdominal motion; respiratory rate >20 bpm; reduced speech/vocal volume; weakened cough; symptoms of sleep disordered breathing; frequent awakening; daytime somnolence, excessive sleepiness in daytime; unexplained confusion, anxiety, headaches or nausea. If patient is unable to participate in VC testing, they may be hospice eligible if three or more of the above symptoms are documented. OR
Severe nutritional insufficiency, as evidenced by events of dysphagia with progressive weight loss of at least 5% of body weight with or without desire for feeding tube.
-
Patients in a comatose state with any three of the following on the third day of coma (any etiology): abnormal brain stem response; absent verbal response; absent withdrawal response to pain; serum creatinine >1.5mg/dl.
The following factors lend supporting documentation of eligibility to hospice: aspiration pneumonia, pyelonephritis, refractory stage 3-4 decubitus ulcers, and recurrent fever despite antibiotics and/or Diagnostic imaging documentation including:
Non-traumatic hemorrhagic stroke as evidenced by large volume hemorrhage on CT as evidenced by infratentorial greater than or equal to 20ml or supratentorial greater than or equal to 50ml; ventricular extension of hemorrhage; surface area involvement of hemorrhage greater than or equal to 30% of cerebrum; midline shift greater than or equal to 1.5cm; obstructive hydrocephalus
Thrombotic/embolic stroke as evidenced by large anterior infarcts with cortical and subcortical involvement; large bihemispheric infarcts; basilar artery occlusion; bilateral vertebral artery occlusion
General Inpatient (GIP) Guidelines for Hospice
* Indicates criteria that must be present; others lend supporting documentation of eligibility.
General inpatient (GIP) is a higher level of care offered on an inpatient basis for hospice patients who have short-term symptom management needs that cannot be met at home. Eligibility is determined according to strict Medicare guidelines, as it is the second most expensive level of hospice care provided.
Anticipated survival time is not a criterion for admission. Acute symptom management need that cannot be met in a lower-level setting is the primary criterion, and additional supporting evidence may include:
Pain management needs that cannot be managed in another setting due to complicated delivery mechanisms, frequent dose titration or frequent monitoring.
Nausea, vomiting, respiratory distress or complications such as seizures or bleeding that cannot be controlled elsewhere.
Advanced, open wounds requiring frequent dressing changes, frequent monitoring or more than one person to complete.
Delirium and behavioral issues that cannot be managed anywhere else.
When to Refer Inpatient Hospice Care
Pete Moore Hospice House is the only specialty inpatient care hospice in the Eugene-Springfield area.
You may want to recommend Pete Moore Hospice House rather than in-home hospice if:
Your patient qualifies for general inpatient care because their symptoms cannot be adequately controlled at home (GIP).
The patient’s family is not able or willing to offer adequate care at home.
The patient’s primary caregiver is no longer able to handle care physically or emotionally, such as an elderly spouse who does not have the physical strength to turn or move their partner.
The patient or family have personal, religious or cultural reasons for not wishing to die in the home.
The patient or family feel more comfortable knowing trained medical personnel are on hand 24/7 in the hospice house.
Your patient’s caregiver needs to take a break from caregiving, either short-term (respite care) or longer term (residential care).
Depending on the situation, Medicare, Medicaid/Oregon Health Plan and private insurance may cover all or some of the cost of Pete Moore Hospice House. Our intake specialists can help determine the level of care needed and explain options and costs with you, your patient and their family.
How to Make a Hospice Referral
Cascade Health’s hospice team works quickly to mobilize care for your patient. Our medical director or intake specialists are available 24/7 to process your referral and will reach out to your patient the same day to establish care. In most cases, they will receive their first in-person visit that same day. Or, if they meet general inpatient requirements, transport to Pete Moore Hospice House can occur within a few hours.
To begin the referral process to Cascade Health Hospice, you may print and complete the Cascade Health Hospice Referral Form and fax it to (541) 228-3182 or call us at (541) 228-3050. If you call, please be prepared to provide the following information:
Patient name, address and phone number.
Patient date of birth.
Diagnosis.
Referring contact and phone number.
Attending physician’s name.
Primary contact/caregiver name, phone number and relationship to patient.
Medicare/insurance ID number, phone number, policy number and name of policyholder.
If you are including a recommendation for Hospice on hospital discharge orders, please refer to Cascade Health by name.
FAQs
-
Any patient with a life expectancy of less than 6 months is a candidate for Hospice.
-
No. The purpose of Hospice is to ease symptoms at the end of life and support a peaceful passing. If a patient wishes to continue curative care, such as chemotherapy, they are not a Hospice candidate. However, if your patient has a serious illness, you may refer them to Palliative Care. Cascade Health Palliative Care supports but does not replace your care or curative treatments but focuses on improving your patient’s quality of life. Cascade Health Palliative Care is consultative in nature, and we make recommendations as opposed to taking over care. To find out if Palliative Care is a better fit for your patient, please visit our Palliative Care page.
-
Hospice can be ordered by a primary physician or specialist, such as an oncologist. Patients may also self-refer or be referred by a family member, social worker, clergy or friend. Regardless of who initiates a referral, to qualify for hospice a patient’s prognosis of six months or less must be certified by two physicians, typically a referring or primary care physician and Cascade Health Hospice’s medical director.
-
Cascade Health’s Pete Moore Hospice House in Eugene is the only independent facility able to meet the needs of GIP patients. While GIP patients may also be referred to a hospital or nursing facility, Pete Moore Hospice House offers exceptional 24/7 care and aggressive symptom management in a comfortable, home-like environment preferred by patients and families.
-
No, any patient who qualifies for hospice may be referred to Pete Moore Hospice House. While we specialize in providing GIP care, we also offer respite stays and residential care, as space allows. Medicare, Medicaid/Oregon Health Plan and most private insurance companies cover all costs for GIP and respite care. Additional room and board charges apply for patients who opt for residential care.
Hospice Education and Training Opportunities in Eugene, Springfield
Cascade Health Hospice offers free 15-minute to 1-hour presentations or can develop a customized seminar or workshop. We can accommodate weekday, evening and weekend schedules to suit your needs.
Topics include:
A road map to hospice care: the how, when, and why of hospice.
When no pain is gain: the art of pain and symptom management.
The hospice story, then and now: the hospice movement, common myths, what families ask us to tell you.
If it’s so important, why is it so hard: family conversations about the end of life.
It’s not just about cancer: the wide range of diseases that qualify.
Help, I’m grieving and can’t get up: practical help with grief and loss.
High touch in a high-tech world: the value of complementary therapy.
Learning to live with dying: how death and dying shape life and spirit.
Caregiving that goes the distance: giving of yourself without losing yourself.
When grief comes to work: professional caregiving and workplace grief.
To learn more about our educational opportunities, contact Steve Belzer, Assistant Manager of Hospice, at (541) 228-3143.
