Table 3

Suggested hospice guidance for Parkinson’s disease and related disorders, one of the following three criteria are required

1. Demonstrates evidence of advanced disease as manifested by either A, B or C criteriaA. Critical nutrition impairment in the prior year (inability to maintain sufficient fluid/caloric intake and dehydration, or BMI<18, or 10% weight loss over 6 months and refusal of artificial feeding methods); or
B. Life-threatening complications in the prior year (recurrent aspiration pneumonia, falls with fractures, pyelonephritis, sepsis, recurrent fever or stage 3 or 4 pressure ulcers); or
C. Motor symptoms that are poorly responsive to dopaminergic medications or which cannot be treated with dopaminergic medications due to unacceptable side effects and result in significant impairments in ability to perform self-care, or
2. Rapid or accelerating motor dysfunction (including gait and balance) or non-motor disease progression (including severe dementia, dysphagia, bladder dysfunction, stridor (in MSA)) and disability (restricted to bed or chair bound status, unintelligible speech, need for pureed diet and/or major assistance needed for ADLs), or
3. Has advanced dementia and meets hospice referral criteria based on: Medicare’s dementia criteria,29 30 Advanced Dementia Prognostic Tool31 criteria or the Minimum Data Set-Changes in Health, End-stage disease and Symptoms and Signs Score criteria.75
  • ADLs, activities of daily living; BMI, body mass index; MSA, multiple system atrophy.