• Impaired breathing capacity
  • Increased assist in ADLs
  • Decline in speech
  • Progression from normal to pureed diet
  • Progression from independent ambulation to wheelchair
  • One or more of the following:
    • Weight loss
    • Aspiration pneumonia
    • UTI
    • Sepsis
    • Recurrent fever
    • Stage 3-4 decubitus ulcers