Medicare Criteria for Hospice Care of Patient with Amyotrophic Lateral Sclerosis (ALS)

FVC as percent of expected (enter from 0 to 100)

• have dyspnea at rest?

• refuse to be mechanically ventilated?

• had a rapid loss of ambulation, with the patient now chair or bed bound?

• had a rapid loss of intelligible speech?

• rapidly progressed from a normal to a pureed diet?

• require assistance in all activities of daily living (ADL)?

• have an oral intake of food and fluids insufficient to sustain life?

• have ongoing unintentional weight loss?

• become dehydrated and/or hypovolemic?

• been unable to receive sufficient artificial nutrition?

• had recurrent episodes of aspiration pneumonia?

• have severe decubitus ulcers?

• have recurrent fevers after appropriate antibiotic therapy has stopped?

• unable to maintain an adequate fluid and caloric intake, with progressive weight loss and hypoalbuminemia?