Medicare has listed criteria for when a patient with amyotrophic lateral sclerosis (ALS) is a suitable candidate for hospice care.


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



• The criteria for mutritional impairment and the 4th life-threatening complication seem to overlap.


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