End of Life Stroke & Coma: What to Expect

End stage neurological conditions like stroke and coma present significant challenges that face patients and their families. Those with end-stage stroke conditions may experience impaired motor function, the inability to speak, inability to eat, severe weakness, paralysis, and declined cognitive ability. The impact on the individual’s physical and cognitive functioning can be profound, and the emotional toll on their loved ones can be immense. A coma is a time in which an individual experiences a prolonged state of unconsciousness. This state is marked by the absence or response to external stimuli and an inability to wake up. Challenges that may arise during a coma may be infection, respiratory distress, and pressure related injuries from spending increased time in bed.

During this challenging time, hospice care provides essential support to both the individual in end-stage stroke and coma and their families. Hospice teams specialize in managing the unique needs and symptoms associated with this stage of stroke. They focus on enhancing comfort, providing pain management, and addressing the individual’s physical needs. Hospice professionals work closely with the individual’s healthcare providers to ensure appropriate medication adjustments, wound care, and infection prevention.

Additionally, hospice care extends its support to the emotional and psychological well-being of both the individual and their family members. They offer counseling, guidance, and bereavement services to help cope with the emotional challenges of end-stage stroke and coma. Hospice teams provide compassionate care, aiming to improve the individual’s quality of life, promote dignity, and support the family’s understanding of the process.

Furthermore, hospice teams collaborate with other healthcare professionals involved in the individual’s care, ensuring a comprehensive and holistic approach. They help facilitate necessary medical equipment and supplies, coordinate with specialists, and provide assistance with practical matters. By addressing the physical, emotional, and practical needs of individuals in end-stage stroke and coma, hospice care can provide valuable support during this difficult journey for both the individual and their loved ones.

Hospice Eligibility Guidelines for End-Stage Neurological Conditions like Stroke & Coma

We understand that navigating the complexities of hospice care can be overwhelming, especially when dealing with a loved one suffering from a stroke of in a coma. This page aims to provide you with a comprehensive guide to the eligibility guidelines for hospice care specifically designed for individuals facing end-stage neurological disease.

Disease Specific Guidelines

Patients who meet the following criteria will be deemed to be in the terminal stage of neurological condition as highlighted below, with a life expectancy of six months or less if the illness runs its course.


  1. Karnofsky Performance Status (KPS) or Palliative Performance Score (PPS) of 40% or less
  2. Inability to maintain hydration and nutrition with one of the following characteristics:
      • Current history of pulmonary aspiration not responsive to intervention by speech language pathology
      • Serum albumin < 2.5 gm/dl
      • Dysphagia (difficulty swallowing) that is severe enough that it prevents the individual from receiving the necessary nutrition and hydration to sustain life when the individual is not receiving or seeking artificial means of hydration and nutrition
      • Weight loss > 10% in the last 6 months or 7.5% in the last 3 months or sequential calorie counts documenting inadequate caloric intake

Coma of any etiology

Comatose patients with any of criteria 1 through 4 on or after day 3 of comatose status. Criteria 5-9 serve only to support eligibility for hospice care:

  1. Absent verbal response
  2. Abnormal brain stem response
  3. Absent withdrawal from painful stimuli
  4. Serum creatinine > 1.5 mg/dl
  5. Aspiration pneumonia
  6. Stage 3-4 decubitus ulcers
  7. Sepsis
  8. Upper urinary tract infection (pyelonephritis)
  9. Fever despite antibiotic therapy

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


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 Stroke or Coma:

Hospice care offers numerous benefits tailored to the specific needs of individuals with end-stage neurological conditions. Some of these benefits include:

1. Pain and Symptom Management: Hospice care focuses on alleviating pain and managing distressing symptoms associated with stroke and coma.

For those with stroke this may include managing symptoms commonly experienced which may include:

  • Pain
  • Fatigue, weakness, and/or paralysis
  • Loss of coordination and/or balance
  • Difficulty speaking or understanding speech
  • Vision problems
  • Incontinence
  • Altered sensations
  • Difficulty swallowing
  • Cognitive decline or impairment
  • Emotional and psychological changes


For those with coma this may include managing symptoms commonly experienced which may include:

  • Lack of purposeful movement
  • Skin breakdown
  • Altered breathing patterns
  • Incontinence
  • Inability to communicate


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 and other necessary equipment related to managing the symptoms that may arise. 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. With stroke and coma, this may include a hospital bed, mobility aides, bedside table, or additional items determined to be necessary by agreement of the hospice team, patient, and caregivers.

3. Emotional and Psychosocial Support: Hospice care extends support not only to patients but also to their families and caregivers. Helping a loved one with stroke or coma can be challenging. Social workers and counselors are available to provide emotional support, counseling, and resources to cope with the challenges that arise during this difficult time. The nursing team is available to assist in educating and guiding you through providing the best care to your loved one.

4. Skilled Nursing Care: Hospice care includes skilled nursing services provided by specially-trained hospice nurses who have expertise in managing the complexities of many conditions, including care of those suffering a stroke or coma. These skilled nurses assess and monitor the patient’s condition, provide anticipatory guidance based on disease progression, educate the patient and caregivers, manage medications, provide wound care if needed, and collaborate with other healthcare professionals to ensure comprehensive care.

5. Assistance with Activities of Daily Living (ADLs): 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 stroke and coma this can be of vital importance due to increased dependence, non-responsiveness/paralysis, easy fatigue, and/or cognitive decline.

6. 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.

7. 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.

8. 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.

If you have any questions regarding hospice eligibility guidelines for individuals suffering a stroke or coma, please feel free to contact us. Our compassionate team at Honor Hospice is dedicated to providing information, support, and personalized care during this challenging time.

Take the first step towards compassionate care and learn how hospice can make a difference in your life or the life of your loved one.