Hospice Eligibility Guidelines for Individuals with COPD and Other End-Stage Lung Disease

We understand that navigating the complexities of hospice care can be overwhelming, especially when dealing with chronic obstructive pulmonary disease (COPD) and other end-stage lung diseases. This page aims to provide you with a comprehensive guide to the eligibility guidelines for hospice care specifically designed for individuals facing COPD and other end-stage lung conditions.

End-stage lung conditions may include:

• Chronic obstructive pulmonary disease (COPD):
  1. Chronic bronchitis
  2. Emphysema
• Pulmonary fibrosis
• Cystic fibrosis
• Chronic asthma
• Tuberculosis (end-stage)
• Bronchiectasis
• Interstitial lung disease
• Respiratory failure
• Lung cancer

Disease Specific Guidelines

Patients who meet the following criteria will be deemed to be in the terminal stage of pulmonary disease, with a life expectancy of six months or less if the illness runs its course. These criteria apply to patients with different forms of advanced pulmonary disease who ultimately follow a final common pathway for end-stage pulmonary disease. The presence of criteria 1 and 2 is mandatory, while documentation of criteria 3, 4, and 5 will provide additional supporting evidence.

1. Severe chronic lung disease as documented by the following:
   1. Dyspnea (shortness of breath) at rest that is poorly or unresponsive to bronchodilators resulting in a decrease in functional capacity.
   2. Progression of end-stage lung disease evidenced by increased use of emergency department visits, hospitalizations, and/or outpatient physician visits due to pulmonary disease.
2. Hypoxemia (decreased oxygen in the blood) at rest on room air evidenced by oxygen saturation ≤ 88% or pO2 ≤ 55mmHg OR persistent hypercapnia as evidenced by pCO2 ≥ 50 mmHg.
3. Right sided heart failure secondary to pulmonary disease (Cor pulmonale).
4. Unintentional progressive weight loss of greater than 10% of body weight over the preceding six months.
5. Resting tachycardia (increased heart rate) > 100 beats per minute.

Non-Disease Specific Guidelines

1. Physiologic impairment of functional status demonstrated by a score < 70% using either:
   1. Karnofsky Performance Status (KPS)
   2. Palliative Performance Score (PPS)
2. Dependence on assistance for two or more of the following activities of daily living (ADLs):
   1. Feeding
   2. Bathing
   3. Dressing
   4. Toileting
   5. Ambulation (walking/moving)
   6. Transfer

Co-morbidities

Although not the primary hospice diagnosis, the presence of certain co-morbidities should be considered in determining hospice eligibility, as the severity of these conditions is likely to contribute to a life expectancy of six months or less. These co-morbidities may include:

• Chronic obstructive pulmonary disease
• Congestive heart failure
• Ischemic heart disease
• Dementia
• Renal failure
• Diabetes mellitus
• Liver disease
• Acquired immune deficiency syndrome (AIDS)
• Neurologic disease (CVA, ALS, MS, Parkinson’s)
• Neoplasia

Disclaimer: Please note that the information provided on this page is intended for general guidance purposes only and should not replace professional medical advice. Each individual’s situation is unique, and eligibility for hospice care should be assessed by qualified healthcare professionals.

 

Benefits of Hospice Care for Individuals with COPD and End-Stage Lung Disease:

Hospice care offers numerous benefits tailored to the specific needs of individuals with COPD and end-stage lung disease. Some of these benefits include:

1. Pain and Symptom Management: Hospice care focuses on alleviating pain and managing distressing symptoms associated with COPD and end-stage lung disease.

For those with end-stage pulmonary conditions this can include managing symptoms commonly experienced which may include:

• Shortness of breath
• Cough
• Weakness and fatigue
• Pain
• Decreased nutrition and weight loss
• Anxiety
• Sleep disturbance
• Cognitive decline

The interdisciplinary team, including physicians, nurses, respiratory therapists, social workers, and chaplains, work together to develop a comprehensive plan that addresses the unique needs of each patient.

2. Medication and Equipment Support: Hospice provides medications, oxygen therapy, and other necessary equipment related to managing the symptoms that may arise with end stage lung disease. This ensures that patients have access to the resources they need to maintain comfort and improve their quality of life. All medications and durable medical equipment related to the terminal condition are covered under the hospice benefit.

3. Emotional and Psychosocial Support: Hospice care extends support not only to patients but also to their families and caregivers. Social workers and counselors are available to provide emotional support, counseling, and resources to cope with the challenges that arise during this difficult time.

4. Skilled Nursing Care: Hospice care includes skilled nursing services provided by specialized hospice nurses who have expertise in managing the complexities of COPD and end-stage lung disease. These skilled nurses assess and monitor the patient’s condition, manage medications, educate the patient, family, and caregivers, provide wound care if needed, and collaborate with other healthcare professionals to ensure comprehensive care.

5. Assitance with Activities of Daily Living: Nurse aides, also known as certified nursing assistants (CNAs), are an integral part of the hospice team. They provide hands-on assistance with activities of daily living (ADLs), such as bathing, dressing, grooming, and toileting. For individuals with COPD who may experience fatigue and physical limitations, nurse aides help maintain personal hygiene, promote comfort, and preserve dignity.

5. 24/7 Access to Care: Hospice care offers round-the-clock access to the hospice team, providing peace of mind for patients and their families. This availability ensures that assistance is available whenever it is needed, even outside regular office hours.

6. Spiritual and Bereavement Support: Hospice care acknowledges the importance of spiritual and emotional well-being during end-of-life care. Chaplains or spiritual counselors are available to provide spiritual support, and bereavement services are offered to help families cope with grief and loss after the passing of a loved one.

7. Self-guidance: An individual is allowed to receive care in their preferred setting and have input on their care allowing for an increased sense of comfort.

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Not sure if you or a loved one are eligible to receive hospice care?

Contact the Honor Hospice team for an evaluation to determine if hospice is an appropriate care option.