Call Anytime+(469)373-7755

Amyotrophic Lateral Sclerosis (ALS)

  • Home
  • Amyotrophic Lateral Sclerosis (ALS)

Amyotrophic Lateral Sclerosis (ALS)

Patients will be considered to be in the terminal stage of ALS if they meet the following criteria: should fulfill 1 2 or 3 should be present; factors from 3

  • Patient should demonstrate critically impaired breathing capacity as demonstrated by all the following characteristics occurring within the 12 months preceding initial hospice certification:
  • • FVC < 40% of normal.
  • • Dyspnea at rest.
  • • Patient declines mechanical ventilation; external ventilation used for comfort measures only.
  • • No invasive ventilation.

  • If unable to perform the FVC test, patient should demonstrate BOTH:
  • A) Rapid progression of ALS as demonstrated by all the following characteristics occurring within the 12 months preceding initial hospice certification:
  • • Progression from independent ambulation to wheelchair to bed-bound status.
  • • Progression from normal to barely intelligible or unintelligible speech.
  • • Progression from normal to pureed diet.
  • • Progression from independence in most or all activities of daily living (ADLs) to needing major assistance by caretaker in all ADLs.
  • • Difficulty breathing at rest or a respiratory rate greater than 20 breaths per minute.
  • • Unexplained confusion or anxiety.
  • • Weakening cough.

  • B) Critical nutritional impairment as demonstrated by all the following characteristics occurring within the 12 months preceding initial hospice certification:
  • • Oral intake of nutrients and fluids insufficient to sustain life.
  • • Difficulty swallowing with a continuing weight loss of 5% or more.
  • • Dehydration or hypovolemia.
  • • Absence of artificial feeding methods, sufficient to sustain life, but not for relieving hunger.

  • Patient should demonstrate BOTH:
  • A) Rapid progression of ALS, see 2.a above
  • B) Life-threatening complications as demonstrated by one of the following characteristics occurring within the 12 months preceding initial hospice certification:
  • • Recurrent aspiration pneumonia (with or without tube feedings); upper urinary tract infection, e.g., pyelonephritis, sepsis; recurrent fever or infection after antibiotic therapy; Stage 3 or 4 decubitus ulcer(s).