Patients with advanced liver failure or cirrhosis will be eligible for hospice if they start meeting the following criteria. Meeting 1-2 of the following list can make a patient eligible for hospice (as determined by a physician). Hospice eligibility will allow the patient to receive additional services which will help alleviate patient symptoms and help with caregiver burdens. These interventions if received early enough may help prolong life given the additional healthcare services received by the patient (Physician, nurses, CNA, Chaplain, Social Worker, etc.). This focus on improving quality of life and reducing patient suffering but does allow for frequent patient check-ins by healthcare staff which help catch issues early and correct them before they spiral out of control.

1. Blood clotting time starts to increase with increased bruising noted. This can be detected in labwork with an INR of greater than 1.5.
2. Albumin levels of less than 2.5 indicating liver failure. This abnormality shows up as increasing edema in the hands/face/feet of the patient with eventual swelling of the belly due to increasing fluid (ascites).
3. Presence of ascites. If the patient’s abdomen starts filling up with fluid this is a sign of advancing liver failure. If the fluid needs to be drained due to ineffectiveness of medications and needs to be done more than every 3 months, the patient is demonstrating advancing liver failure. This finding can be further complicated by infection of the fluid in the belly (SBP), development of kidney failure in addition to liver failure (Hepato-Renal Syndrome), progressive confusion due to toxin build up (hepatic encephalopathy).
4. Increasing muscle wasting evidenced by loose clothes, muscle atrophy noted on exam, increasing weakness, and increasing dependence on caregivers for activities of daily living. If the patient needs help with more than 1 activity of daily living (transferring from bed to chair or chair to walking, incontinence, bathing/showering, dressing oneself, walking, and feeding oneself) in the setting of liver cirrhosis, it may signal that the patient may be hospice eligible.

Patients who are ACTIVELY awaiting a liver transplant and fulfill the above criteria may be certified for hospice . However, if a suitable donor organ becomes available, the patient must be discharged from hospice care to proceed with the transplant.