Debility Unspecified & Failure to Thrive:
Common Hospice Diagnoses
Author: Linh Nguyen, MD
Debility Unspecified and Failure to Thrive diagnoses allow more patients to appropriately receive hospice benefits.
While not always evident initially, upon further review the patient may have multiple risk factors which, when grouped together, meet hospice criteria.
Multiple risk factors may include sudden or progressive decline in:
- nutritional intake,
- weight loss, and
- mental function (disorientation, confusion or delirium).
Diagnostic studies or treatment may have been offered but declined, or not feasible.
Common objective hospice tools may be utilized to show a decline in:
- body mass index (BMI),
- palliative performance scale,
- mid-muscle area measurement,
- functional assessment scale level,
- and diagnostic studies including: ejection fraction, glomerular filtration rate, forced expiratory volume in 1 second, or blood studies.
Multiple borderline factors justify hospice admission.
General hospice guidelines
- Terminal prognosis of 6 months or less and patient/family have elected palliative care
- Declining functional status
- Palliative performance scale (PPS) ≤50-60%
- Dependence in 3 of 6 ADLs
- Alteration in nutritional status: more than 10% loss of body weight over last 4-6 months
- Observable and documented deterioration in overall clinical condition in the past 4-6 months, as manifested by at least one of the following
- Multiple (≥3) hospitalizations or emergency department visits
- Decrease in tolerance to physical activity
- Decrease in cognitive ability
- Other comorbid conditions
See disease-specific guidelines for other hospice diagnoses
Diagnosis of Failure to Thrive and Debility Unspecified
- Failure to Thrive
- Strictly a weight loss diagnosis
- BMI < 22
- Unexplained weight loss
- An obese patient may have BMI > 22 but lost 20% or more their body weight
- No other medical problems but functional decline
- Debility Unspecified
- Used when no other diagnosis for a terminally ill patient is appropriate
- Has multiple risk factors for decline yet does not meet hospice criteria in any one specific diagnostic category
- Hospice referral may be made by a primary physician who has known the patient well enough to notice a definite physical or mental decline and strongly believes the patient is at risk of dying
- Family and caregivers usually confirm the decline
- The most serious disease is used as a monitoring base
- Patients who do not meet disease specific guidelines can still receive hospice benefits if they have multiple comorbid conditions that put them at risk of dying.
- As of May 2013, there was a proposal for Medicare and Medicaid to review these diagnoses; however, the rules have not changed as of this writing.
VITAS. (2013). VITAS Hospice Eligibility Reference Guide [Mobile application software]. Retrieved from http://itunes.apple.com