Table 1

Current Medicare hospice guidelines for neurologic disorders with potential relevance to Parkinson’s disease and related disorders29 30

Dementia1. Stage 7C or higher on the FAST Scale, AND
2. One or more of the following in the past year: aspiration pneumonia, pyelonephritis, septicemia, stage 3 or 4 pressure ulcers, recurrent fevers, other conditions suggesting limited prognosis or inability to maintain sufficient fluid/caloric intake in past 6 months (10% weight loss or albumin<2.5 g/dL)
Stroke or coma1. Palliative Performance Scale Score≤40%, AND
2. Poor nutritional status with inability to maintain sufficient fluid/caloric intake (10% weight loss in 6 months, 7.5% weight loss in 3 months, serum albumin≤2.5 g/dL or pulmonary aspiration resistant to speech therapy interventions)
ALS (also listed as ‘other neurologic disease including ALS, PD, MD, MG or MS’)1. Critically impaired breathing including dyspnoea at rest, vital capacity<30%, oxygen need at rest and refusal of artificial ventilation, OR
2. Rapid disease progression (to bed-bound status, unintelligible speech, need for pureed diet and/or major assistance needed for ADLs) with either:
-A. Critical nutrition impairment in the prior year (inability to maintain sufficient fluid/caloric intake, continuing weight loss, dehydration and refusal of artificial feeding methods), OR
-B. Life-threatening complications in the prior year (recurrent aspiration pneumonia, pyelonephritis, sepsis, recurrent fever or stage 3 or 4 pressure ulcers)
Generic1. Terminal condition (can be multiple conditions), AND
2. Rapid decline over past 3–6 months as evidenced by progression of disease signs, symptoms and test results, decline in PPS≤40%, involuntary weight loss>10% and/or albumin<2.5 g/dL
  • ADL, activities of daily living; ALS, amyotrophic lateral sclerosis; FAST, Functional Assessment Staging Test; MD, muscular dystrophy; MG, myasthenia gravis; MS, multiple sclerosis; PD, Parkinson disease; PPS, Palliative Performance Scale.