When a loved one is living with a serious illness, families often hear unfamiliar terms and numbers during conversations about hospice. The Palliative Performance Scale (PPS) and Karnofsky Performance Status (KPS) are twoย toolsย clinicians may use to describe how illness is affecting everyday life. Understanding what these scores measureโand what they do notโcan make the hospice assessment process feel less confusing.ย
Why Hospice Teams Use Assessment Toolsย
Hospice eligibility is based on the whole person, not a single test result. Under Medicare, a physician must certify that a person has a life expectancy of six months or less if the terminal illness follows its normal course.ย Because serious illnesses do not progress in exactly the same way for every person, clinicians look at several kinds of information together.ย
Performance scales give the care team a consistent way to describe changes in strength,ย independenceย and support needs. The team may also review the personโs diagnosis, symptoms, recent hospitalizations, weight loss, infections, ability to eat and drink, cognitiveย changesย andย need forย help with daily activities. Changes over time are often more informative than one score recorded on one day.ย
What Is the Palliative Performance Scale?ย
The Palliative Performance Scale was adapted from the KPS for use with people receiving palliative care. PPS scores range from 100% to 0% in 10% steps. A higher score reflects greater independence, while a lower score reflects more advanced functional decline and a greater need forย assistance.ย
The PPS considers five observable areas:ย
- Ambulation, or how well the person can move aroundย
- Activity level and evidence of diseaseย
- Ability to complete self-careย
- Food and fluid intakeย
- Level of consciousnessย
Because PPS includes intake and alertness in addition to physical function, it can help describe changes that families commonly notice as a serious illness advances. A hospice clinician looks for the score that best fits the personโs current condition and considers how that score is changing over time.ย
What Is the Karnofsky Performance Status?ย
The Karnofsky Performance Status also ranges from 100% to 0% in 10% steps. It was originally developed to describe the functional ability of people with cancer andย remainsย common in oncology,ย researchย andย serious-illnessย care.ย
KPS focuses on whether a person can carry out normal activities,ย workย and care for themselves, as well as how muchย assistanceย or medical support they need. Like PPS, a lower KPS scoreย indicatesย greater functional impairment. KPS does not separately score food intake or consciousness, which is one reason PPS may offer a more detailed picture in palliative and hospice settings.ย
KPS vs. PPS: A Side-by-Side Comparisonย
| Comparisonย | PPSย | KPSย |
| Full nameย | Palliative Performance Scaleย | Karnofsky Performance Statusย |
| Primary focusย | Function in the context of serious illness and palliative careย | Overall ability to perform ordinary activities and care for oneselfย |
| What it considersย | Walking, activity and disease, self-care,ย intakeย and consciousnessย | Activity, work,ย self-careย and the amount ofย assistanceย neededย |
| Scoringย | 100% to 0% in 10% steps; lower scores reflect greater decline and support needsย | 100% to 0% in 10% steps; lower scores reflect greater functional impairmentย |
| Common useย | Palliative care,ย hospiceย and serious-illness assessmentย | Cancer care, prognosis, treatmentย decisionsย and hospice assessmentย |
| Family takeawayย | Offers a broader picture of day-to-day changes near the end of lifeย | Providesย a straightforward view of independence and functional abilityย |
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Important:ย A PPS or KPS score is not a pass-or-fail test for hospice. Medicare coverage guidance may reference scores below 70% as one sign of functional decline, while certain diagnoses may use different supporting thresholds. Eligibility still depends on the personโs overall clinical condition and a physicianโs judgment about prognosis.ย
Other Tools Used During a Hospice Assessmentย
PPS and KPS are broad measures of performance. Depending on the illness, clinicians may use other hospice assessment tools to understand a specific type of decline.ย
FAST for Alzheimerโs Disease and Dementiaย
The Functional Assessment Staging Tool (FAST) describes the progression of Alzheimerโs disease by looking at changes in abilities such as dressing, bathing, toileting,ย walkingย and communication. FAST is most useful when dementia is the primary terminal diagnosis, and clinicians also consider complications and other health conditions.ย
ECOG Performance Statusย
The Eastern Cooperative Oncology Group (ECOG) scale describes how much an illness limits daily activity. It uses a shorter scale than PPS or KPS and is often used in cancer care and clinical research. It may contribute useful information, but it is not a stand-alone hospice eligibility test.ย
NYHA Functional Classification for Heart Diseaseย
The New York Heart Association (NYHA) classificationย groupsย heart failure symptoms into four classes based on how much physical activity is limited. Class IV describes symptoms at rest and severe limits on activity. Hospice teams consider this classification alongside treatment response, symptoms,ย hospitalizationsย and other evidence of decline.ย
Activities of Daily Living and Disease-Specific Criteriaย
Clinicians also assess activities of daily living, or ADLs, including bathing, dressing, eating, toileting,ย transferringย and walking. Needing help with several of these activities can show increasing dependence. For conditions such as lung disease, liver disease, kidney disease, ALS or stroke, the assessment may also include diagnosis-specific symptoms, testย resultsย and complications.ย
What Families Can Shareย Withย the Care Teamย
Families often see meaningful changes before they appear clearly in a medical record.ย Sharing specific examples can help the care team understand the full picture.ย Helpful observations may include:ย
- Needing more help with bathing, dressing, eating, toileting or moving safelyย
- Spending more time in a chair or bedย
- Eating or drinking less, losingย weightย or having difficulty swallowingย
- Sleeping more, becoming lessย alertย or experiencing increased confusionย
- Having more pain, shortness of breath,ย weaknessย or other difficult symptomsย
- Experiencing repeated infections, falls, emergencyย visitsย or hospitalizationsย
- No longerย benefitingย fromโor choosing not to continueโtreatments aimed at curing the terminal illnessย
There is no need to calculate a score on your own. A hospice clinician can complete the assessment, explain what the findingsย meanย and answer questions aboutย nextย steps.ย
The Full Story Matters More Than One Numberย
PPS,ย KPSย and other assessment tools help clinicians speak a common language, but they cannot capture everything that matters to a patient or family. A meaningful hospice evaluation also considers the personโs goals, values, symptoms, medicalย historyย and the ways illness is changing daily life.ย
At Compassus, care starts by listening. Ourย Care for who I amย approachย helps us understand each person as an individualโnot simply as a diagnosis or score. If you are wondering whether hospice may beย appropriate forย you or someone you love, you can request an evaluation and talk through your questions with a local care team.ย
Call Compassus at 833-380-9583 to learn more about hospice eligibility and support available in your area.ย
This information is for educational purposes and does not replace an individualized assessment or medical advice from a qualified health care professional.
