How to Use the Palliative Performance Scale in Home Health Care

As home health agencies continue to support patients with complex and rapidly evolving needs, standardized tools have become essential for guiding care decisions and improving communication. One tool widely used in palliative and hospice settings is the Palliative Performance Scale (PPS). Developed by Victoria Hospice in Canada, the PPS provides a reliable method for assessing a patient's functional status and estimating prognosis in a palliative care context.

This article outlines the structure of the PPS, how it's used in clinical settings, and what its scores mean for patient care planning. By understanding how to apply the PPS in daily operations, agencies can strengthen care coordination and better support patients and families during serious illness.

What Is the Palliative Performance Scale?

The Palliative Performance Scale is a validated tool that helps clinicians assess a patient’s functional status across five key domains: ambulation, activity level and evidence of disease, self-care, intake, and level of consciousness. It is scored in 10-percent increments from 100 (fully functional) to 0 percent (death) and is widely used in both hospice and palliative home care to support care planning and eligibility assessments.

Unlike many assessment tools that rely heavily on diagnosis, the PPS is function-based. This allows care teams to quickly capture the real-world condition of patients whose decline may be more gradual or variable. The PPS score is determined based on clinical observation without requiring patient self-reporting or extensive diagnostic data.

Interpreting PPS Scores: Clinical Application

Each PPS level corresponds to observable characteristics in five functional domains. Here's a quick reference clinicians can use to guide assessment and care planning:

PPS Score	Ambulation	Level of Function
100%	Fully mobile	Healthy and independent with no signs of illness
90%	Fully mobile	Minor symptoms; able to work and perform usual duties
80%	Fully mobile	Some effort required for normal tasks
70%	Reduced mobility	Unable to work but able to manage self-care
60%	Limited mobility	Needs occasional help; restricted in routines
50%	Mainly sits or lies down	Requires regular help with self-care
40%	Mainly bedbound	Dependent for most tasks
30%	Completely bedbound	Needs full assistance
20%	Bedbound	Minimally responsive, very limited intake
10%	Bedbound	Near death, only mouth care possible
0%	—	Death

Understanding these levels allows clinicians to monitor meaningful functional changes over time and better determine when to reassess care goals or explore hospice eligibility.

How PPS Scoring Informs Prognosis, Planning, and Transitions

Estimating Prognosis

One of the most widely recognized uses of the PPS is in estimating a patient’s prognosis. Research has shown strong correlations between PPS scores and survival time, particularly in hospice-eligible populations. Lower PPS scores were associated with significantly shorter survival, especially in inpatient settings.² For instance, hospice care may be appropriate for patients with a PPS score below 70 percent, as scores in this range often reflect significant functional decline and greater care needs.

Supporting Regulatory Compliance

PPS scores are also commonly used by payers, including Medicare, to support documentation for hospice admission. This makes consistent, accurate scoring essential not only for guiding care but also for ensuring regulatory and reimbursement compliance.

Informing Care Transitions

In home health settings, this prognostic insight can assist with care transitions. When a patient’s PPS score drops significantly, it can signal the need to discuss care goals, reassess the appropriateness of the current plan, and consider whether hospice services should be initiated.

Enhancing Communication and Shared Understanding

In addition to supporting clinical decisions, the PPS offers a shared language that helps patients, families, and care teams understand functional changes and what they may mean. This clarity can guide more meaningful conversations around care planning and goals of care.

From Assessment to Action: A Real-World Example

A patient with advanced heart failure begins receiving home health services following a recent hospitalization. At admission, they are assessed at a PPS score of 60 percent, indicating reduced activity and occasional need for assistance. Over the next several weeks, the care team observes increasing fatigue, decreased appetite, and reduced mobility. By week six, the patient’s PPS score declines to 40 percent. Based on this functional change, the team initiates a family meeting to discuss the patient’s goals of care, review clinical needs, and explore whether a transition to hospice services may be appropriate.

PPS in Daily Home Health Practice

The PPS is often integrated into initial assessments and reassessments at regular intervals. While not mandated across all settings, its use in home health agencies has grown, especially among organizations working closely with palliative and hospice partners. Incorporating the PPS into routine documentation offers several operational advantages, including:

• Standardized communication: PPS scores provide a shorthand for interdisciplinary teams to discuss patient status quickly and clearly. They also help ensure that everyone, from nurses to case managers, is aligned on the patient’s current condition.

• Care coordination: Consistent PPS tracking can improve coordination between home health and hospice providers, especially when patients are nearing end-of-life. It offers an objective reference point to guide timely referrals and smooth transitions in care.

• Documentation support: The PPS supports clinical narratives in documentation, which can be helpful for audits or payer reviews. It can also demonstrate medical necessity and support eligibility for hospice or higher levels of care.

Best Practices for Implementing the PPS

While the PPS is simple to apply, consistent scoring requires alignment across the clinical team. To ensure accurate, meaningful use, consider the following strategies:

• Train all clinical staff on how to evaluate each domain objectively to reduce scoring variability.

• Use real-time observation instead of relying solely on documentation or patient/family reports.

• Reassess regularly, particularly when there’s a significant clinical event, hospitalization, or functional decline.

• Document changes with rationale to support interdisciplinary communication and payer documentation.

• Create internal guidelines for when PPS scores should trigger care plan updates or hospice referral discussions.

Implementing the PPS as part of your standard workflow can support better decision-making while reinforcing a consistent, patient-centered approach across care transitions. Teams can also integrate PPS scoring into EMR templates or QA audits to encourage consistent use and highlight trends in patient trajectories.

Elevating Care Planning With the PPS

When integrated into routine care, the Palliative Performance Scale not only enhances clinical decision-making but also helps ensure patients receive the right support at the right time. In home health, where patient needs can shift quickly, the PPS provides a practical framework for assessing function, anticipating needs, and initiating timely conversations about goals of care.

By incorporating the PPS into routine assessments, home health organizations can strengthen care continuity, support timely transitions, and elevate documentation standards to improve outcomes for patients and families.

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References

1. Bischoff, K. E., Patel, K., Boscardin, W. J., O'Riordan, D. L., Pantilat, S. Z., & Smith, A. K. (2024). Prognoses Associated With Palliative Performance Scale Scores in Modern Palliative Care Practice. JAMA network open, 7(7), e2420472. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820863