HOPSPICE AMYOTROPHIC LATERAL SCLEROSIS (ALS)

Criteria:
Patients will be considered to be in the terminal stage of if they meet the following criteria (must fulfill 1, 2, or 3):

1. The patient must demonstrate critically impaired breathing capacity

a. Critically impaired breathing capacity as demonstrated by all the following characteristics occurring within the 12 months preceding initial hospice certification:

·         Vital capacity (VC) less than 30% of normal

·         Significant dyspnea at rest

·         Requiring supplemental oxygen at rest

·         Patient declines artificial ventilation

2. Patient must demonstrate both rapid progression of ALS and critical nutritional impairment

a. Rapid progression of ALS as demonstrated by all the following characteristics occurring within the 12 months preceding initial hospice certification:

·         Progression from independent ambulation to wheelchair or bed bound status

·         Progression from normal to barely intelligible or unintelligible speech

·         Progression from normal to pureed diet

·         Progression from independence in most or all activities of daily living (ADLs) to needing major assistance by caretaker in all ADLs.

b. Critical nutritional impairment as demonstrated by all the following characteristics occurring within the 12 months preceding initial hospice certification:

·         Oral intake of nutrients and fluids insufficient to sustain life

·         Continuing weight loss

·         Dehydration or hypovolemia

·         Absence of artificial feeding methods

3. Patient must demonstrate both rapid progression of ALS and life-threatening complications

a. Rapid progression of ALS, see 2.a. above

b. Life-threatening complications as demonstrated by one of the following characteristics occurring within the 12 months preceding initial hospice certification:

·         Recurrent aspiration pneumonia (with or without tube feedings)

·         Upper urinary tract infection, e.g., pyelonephritis

·         Sepsis

 

 

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Grace Hospice of Texas

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