Hospice PPS Scales

Determine if your patient is eligible for hospice care and formulate a plan of comfort with the help of our Hospice PPS Scale Template.

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What is a Hospice PPS Scale?

A , also known as the Palliative Performance Scale (PPS) is an objective diagnostic tool used to evaluate the status of patients, determine if they are eligible for hospice, and measure the length of survival or stay. It’s a modification of the Karnofsky Performance Scale that can also determine the level of care and support the patient needs.

The scale allows for scoring patients on a range from 0 to 100. A score of 0 signifies the patient's demise, while a score of 100 indicates a state of robust health and complete mobility. The scale is a spectrum divided into 11 levels, and a patient is given a particular score depending on their performance status as seen in the evidence of their disease, consciousness level, and capability to ambulate, care for themself, eat, drink, and do activities.

To be eligible for hospice, oncology patients must have a score of 70% or below, and patients diagnosed with other diseases must have a score of 50% below. In addition to the scores, patients are only eligible if their doctor states they have less than 6 months to live.

Practitioners like yourself can easily find the Hospice PPS Scale online or in books. However, if you need a handy guide or document to record the patient’s level within the Hospice PPS scale, we have a template you can use.

On our template are instructions on determining the patient’s PPS score and dedicated space for notes on the patient.

To grab a copy you can use, keep reading for information on how to access and download our Hospice PPS Scales template.

Printable Hospice PPS Scale

Download this Hospice PPS Scale to determine if your patients are eligible for hospice care.

How does it work?

Step One. Download the Template 

To access and download a copy of our printable hospice PPS scales template, you can do either of the following:

  • Click the “Download Template” or “Use Template” button above
  • Searching “Hospice PPS Scales” in Carepatron’s template library on our website or app. 

Step Two. Assess the Patient

Though we’ve provided instructions on the template, here’s a quick step-by-step on determining your patient’s PPS Score. 

  • Assess their ambulation by determining if they can move around
  • Look over relevant test results and observe your patient to see if there’s evidence of the disease and if they are capable of participating in their activities
  • Consider the patient’s ability to perform self-care tasks such as grooming, dressing, and bathing and whether or not they require assistance to do them
  • Evaluate the patient’s intake of fluids and food and see if it’s normal or reduced
  • Check your patient’s level of consciousness, whether they are fully alert, drowsy, or in a coma

Step Three. Score, Note, and Store

After observation and assessment, you may assign a score. Note it down in the dedicated space in the template along with other findings or observations, and store the filled-out documents in a secure location or HIPAA-compliant EHR like Carepatron. 

Hospice PPS Scales Example (sample)

We have provided a filled-out hospice PPS scales PDF for your reference. You may open our example to have an idea of what to write in the dedicated space below. 

View our example by clicking the sample below or the “Download Example PDF” button above. 

Download this Hospice PPS Scale Example:

Hospice PPS Scales Example (sample)

When would you use this Template?

Palliative or hospice care practitioners can use our Hospice PPS Scale template when assessing a patient’s eligibility for hospice care. More specifically, it’d be beneficial for a practitioner to have a copy of this template on hand if the patient:

  • Is diagnosed with a terminal or life-limiting illness
  • Has less than 6 months to live, according to their doctor
  • Has decided to stop curative or life-prolonging treatments

The template may also be used for formulating strategies to provide as much comfort to these patients as possible. They can help by providing symptom relief, supporting all aspects of their life, and providing suggestions/recommendations on end-of-life decisions.


Easy to Use and Understand

Whether you’re familiar with the PPS scale or not, you’ll find that our template is easy to use and understand because of its straightforward layout. We’ve also ensured that our scale follows the standardized version and has instructions on how to check your patient. 


Palliative and hospice care practitioners aren’t the only ones who can use this template. Anyone caring for a patient in hospice will find this template extremely helpful, especially when determining the speed of the decline and formulating a care plan in response to that. 

Monitors a Patient’s Condition

Practitioners and caretakers can also utilize the template to monitor the patient’s condition to see how fast their condition is worsening and formulate a plan to provide them with as much comfort as possible. 

Fully Digital and Accessible

The Free Hospice PPS Scale isn’t only entirely digital, which makes it easy to customize, fill out, and store via Carepatron, a secure EHR, but it’s also accessible on any device you have on hand. 

Research & Evidence

Numerous studies have shown that the Palliative Performance Scale or PPS is an effective tool, especially when determining or estimating the duration of survival in cancer patients in particular. However, some of the aforementioned studies have also recommended further research on using PPS on patients with other diseases living outside the U.S. As for using the scale to determine hospice eligibility, aside from articles and books mentioning that the tool can be used for that purpose, studies that prove its usefulness for the mentioned purpose are few and far between, if any.

Commonly asked questions

Who uses the Hospice PPS Scale?

Physicians, nurses, social workers, OT, PT, and any medical practitioner caring for a terminally ill patient may use our hospice PPS scale template. 

When do you use the Hospice PPS Scale?

You can use the scale when the patient is diagnosed with a terminal illness.

How to score and interpret the Hospice PPS Scale?

You score the hospice PPS Scale by following the instructions on the template and assigning the corresponding score and description that matches your results and observations. To interpret, if a cancer patient gets a score of below 70% and a patient of another illness/condition gets below 50%, they are eligible for hospice.

Why use Carepatron as your Hospice PPS Scale app?

It’s because you can raise the caliber of your practice with Carepatron. Aside from obtaining unique yet standardized templates like the Hospice PPS Scale from our app, with our software, you can streamline processes and automate tasks that’ll help you be more efficient and productive. That way, most of your time and focus will be on the patients under hospice care. 

Download the Carepatron app on your desktop or mobile device, and with our features, you can:

Control your Schedule: 

  • Have your patients request appointments independently
  • Keep your medical appointments private with our calendar tool
  • Sync your calendar with our calendar. 
  • Send automated reminders to your clients via email and SMS. 

Manage Clinical Documents: 

  • Download over 700 PDF templates of medical documents you can edit on Carepatron or your local PDF editor. 
  • Scan or upload personal and other documents not found in our library. 
  • Create notes at the tip of your fingertips. 
  • Store them in a HIPAA-compliant EHR. 

Handle Online Therapy Payments

  • Automate invoice creation
  • Process payments in minutes
  • Use automated reminders

. . . and more! 

Don’t miss out on getting access to all of these for free! Sign up on Carepatron today. 

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Baik, D., Russell, D., Jordan, L., Dooley, F., Bowles, K. H., & Masterson Creber, R. M. (2018). Using the Palliative Performance Scale to Estimate Survival for Patients at the End of Life: A Systematic Review of the Literature. Journal of palliative medicine, 21(11), 1651–1661. https://doi.org/10.1089/jpm.2018.0141

Prompantakorn, P., Angkurawaranon, C., Pinyopornpanish, K., Chutarattanakul, L., Aramrat, C., Pateekhum, C., & Dejkriengkraikul, N. (2021). Palliative Performance Scale and survival in patients with cancer and non-cancer diagnoses needing a palliative care consultation: a retrospective cohort study. BMC palliative care, 20(1), 74. https://doi.org/10.1186/s12904-021-00773-8

Who uses the Hospice PPS Scale?
Who uses the Hospice PPS Scale?
Written by
Patricia Buenaventura
Patricia Buenaventura

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