Hospice, Inc.

Metropolitan

    
Guide to Eligibility  Diagnoses   Q & A
Amyotrophic Lateral Sclerosis (ALS)
© 2004 Metropolitan Hospice Inc. All rights reserved
The patient meets at least one of the following (1 or 2):
1. Critically impaired breathing capacity with all of the following findings:
  • Dyspnea at rest
  • Vital capacity less than 30%
  • Requirement for supplemental oxygen at rest
  • The patient declines artificial ventilation
OR
2. Rapid disease progression with either A or B below

Rapid disease progression as evidenced by all of the following in the preceding twelve (12) months:

  • Progression from independent ambulation to wheelchair or bed-bound status
  • Progression from normal to barely intelligible or unintelligible speech
  • Progression from normal to barely intelligible or unintelligible speech
  • Progression from independence in most or all Activities of Daily Living (ADLs) to needing major assistance by caretaker in all ADLs

 

AND
A. Critical nutritional impairment demonstrated by all of the following in the preceding twelve (12) months:
  • Oral intake of nutrients and fluids insufficient to sustain life
  • Continuing weight loss
  • Dehydration or hypovolemia
  • Absence of artificial feeding methods
OR
B. Life-threatening complications demonstrated by one or more of the following in the preceding twelve (12) moths:
  • Recurrent aspiration pneumonia (with or without tube feedings)
  • Upper urinary tract infection (e.g. pyelonephritis)
  • Sepsis
  • Recurrent fever after antibiotic therapy
  • Stage 3 or Stage 4 decubitus ulcer(s)
In the absence of one or more of the above findings, rapid decline or comorbidities may also support eligibility for hospice care.