HOSPICE STROKE AND/OR COMA                

·         A Palliative Performance Scale (PPS) of > 40.

a. Degree of ambulation
          • Mainly in bed
b. Activity/extent of disease
          • Unable to do work; extensive disease
 c. Ability to do self-care
          • Mainly Assistance
 d. Food/fluid intake
          • Normal to reduced
e. State of consciousness
          • Either fully conscious or drowsy/confused

 Inability to maintain hydration and caloric intake with one of the following:

a. Weight loss =10% during previous 6 months

b. Weight loss =7.5% in previous 3 months

c. Serum albumin < 2.5 gm/dl

d. Current history of pulmonary aspiration without effective response to speech language pathology interventions to improve dysphagia and decrease aspiration events.

 

Calorie counts documenting inadequate caloric/fluid intake.
If a beneficiary does not meet both medical criteria #1 and #2 the documentation should describe a relevant comorbidity and/or rapid decline.

The medical criteria listed below would support a terminal prognosis for individuals with a diagnosis of coma (any etiology):

Comatose patients with any 3 of the following on day three of coma:

          a) abnormal brain stem response

 

b) absent verbal response

 

c) absent withdrawal response to pain

 

d) serum creatinine >1.5 mg/dl

 

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