Hospice Eligibility Guidelines for Neurological Diseases

Are you a patient, family member, or caregiver? Learn about how VITAS can help patients with end-stage neurological diseases.

When is your patient with neurological disease ready for hospice care?

Neurological diseases such as coma, stroke, Parkinson’s disease and multiple sclerosis are life-altering conditions that can lead to permanent deterioration of the nervous system.

Patients with neurological diseases may be eligible for hospice when they experience the following signs or symptoms:

• Severely compromised breathing, marked by inability to clear respiratory secretions, persistent cough, or recurring aspiration pneumonia
• Increased shortness of breath, even at rest or on oxygen
• Inability to swallow liquids or soft food without choking or coughing; progression to a mainly pureed diet
• Spends most of the time in the same room, chair or bed
• Barely intelligible speech
• Continued weight loss
• Inability to manage most activities of daily living

In addition, patients with neurological diseases become eligible for hospice when they experience continuous decline in clinical or functional status over time, leading to a poor prognosis.

Intercurrent illnesses associated with neurological disease include:

• Pneumonia
• Sepsis
• Upper urinary tract infection or other infection, despite antibiotic therapy
• Abnormal/absent brain response, verbal response or withdrawal response to pain

In general, patients who are eligible for hospice are thought to have a prognosis of six months or less if the disease runs its normal course. When improvement is unlikely, or when a decision is made to discontinue a feeding tube or ventilator/breathing support, hospice care should be considered.

VITAS provides these guidelines as a convenient tool. They do not take the place of a physician's professional judgment.

Sources:

• National Hospice and Palliative Care Organization. (2018). NHPCO Facts and Figures: 2018 Edition.Retrieved from: https://www.nhpco.org/wp-content/uploads/2019/07/2018_NHPCO_Facts_Figures.pdf
• Parkinson’s Foundation. (2019). Understanding Parkinson’s - Statistics. Retrieved from: https://www.parkinson.org/Understanding-Parkinsons/Statistics
• National Multiple Sclerosis Society. (2019). MS FAQs. Retrieved from: https://www.nationalmssociety.org/What-is-MS/MS-FAQ-s
• Temel, et a. (2010). Early palliative care for patients with metastatic non–small-cell lung cancer. New England Journal of Medicine, 363(8), 733-742.