Criteria for hospice entry - one or more of the following:
(1) severe respiratory impairment (critically impaired breathing)
(2) rapid ALS progression AND critical nutritional impairment
(3) rapid ALS progression AND one or more life-threatening complications
Severe respiratory impairment requires ALL of the following:
(1) dyspnea at rest
(2) FVC < 30% of expected
(3) refusal of mechanical ventilation
Rapid disease progression involves:
(1) rapid loss of independent ambulation, with the patient chair or bed bound
(2) rapid loss of intelligible speech
(3) rapidly progressed from a normal to a pureed diet
(4) requires assistance in all activities of daily living (ADL)
Critical nutrition impairment requires ALL of the following:
(1) oral intake of food and fluids insufficient to sustain life
(2) ongoing unintentional weight loss
(3) dehydration and/or hypovolemia
(4) unable to receive sufficient artificial nutrition
Life-threatening complications include:
(1) recurrent aspiration pneumonia
(2) severe decubitus ulcers
(3) recurrent fever after appropriate antibiotic therapy
(4) inability to maintain an adequate fluid and caloric intake, with unintentional weight loss of >= 10% over the past 6 months and/or serum albumin < 2.5 g/dL
where:
• The criteria for mutritional impairment and the 4th life-threatening complication seem to overlap.
