Tuesday, July 26, 2022

Parkinson’s Disease Hospice Criteria

What Can Hospice Do For The Family Of A Person With A Serious Neurological Disease

21st Century Advanced Parkinson’s Disease & Palliative Care

Family members may have to make difficult healthcare and financial decisions, act as caregivers and provide emotional support to others. If the decision is made to stop medical support, families experience strong emotions and feel overwhelmed. Some of VITAS comprehensive services for families of patients with advanced neurological disease include:

Data Abstraction And Risk Assessment

Any two of three investigators independently screened titles, abstracts and retrieved full papers with eligibility criteria. Differences were resolved by review of the third investigator.

We assessed risk of bias by reviewing study design characteristics, including appropriate temporal relationships between exposures and outcomes, matching populations through individual variables or propensity scores and other adjustment methods. However, given we did not develop a meta-analysis from the findings, we did not exclude reporting any studies that met our inclusion criteria.

When Is The Right Time To Ask About Hospice

Some neurological diseases cause a slow decline over months or years. Others, like stroke, can cause abrupt loss of function. Either way, it can be difficult to determine when the time is right for hospice. In general, hospice patients are thought to have six months or less to live. When improvement is unlikely and a decision is made to discontinue the use of a feeding tube or breathing machine, hospice care for neurological diseases is likely to benefit the patient and family.

Only a doctor can make a clinical determination of life expectancy. However, look for these common signs that the disease has progressed to a point where all involved would benefit from hospice services:

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How Does One Apply For Hospice Services

Physicians initiate the enrollment process for a person with PD by making a referral to a hospice agency. Families can have input in the selection of the hospice agency by getting recommendations from outside resources or by researching local agencies. The National Association for Home Care and Hospice provides information on how to locate hospice services at: .

Once the doctor has sent a referral to the agency, a hospice nurse will come to the home for an initial assessment to determine if the person with PD is eligible. If the individual qualifies, he or she will be evaluated for their specific needs, types of services, frequency of care and equipment.

When To Seek Hospice Care


When you or your loved one have a life expectancy of six months or less, you become eligible for hospice care a type of comfort care provided at the end of life for someone living with end-stage Parkinsons disease. Hospice provides extra support so your loved one can live as comfortably as possible.

If you have experienced a significant decline in your ability to move, speak, or participate in activities of daily living without caregiver assistance, its time to speak with a hospice professional.

Read more: What is hospice care?

Some of the things that determine whether your loved one with end-stage Parkinsons is eligible for hospice include: difficulty breathing, bed bound, unintelligible speech, inability to eat or drink sufficiently, and/or complications including pneumonia or sepsis.

If you live in South Jersey, our nurse care coordinator can answer your questions and decide if your loved one is ready for hospice care. Call us 24/7 at 229-8183.

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My Parkinson’s Story: Advanced Parkinsons

This 10-minute video alternates between an interview with a man and his wife and his palliative care team, including a doctor, nurse, clerg and social worker. The man and his wife shares his experience with late stage Parkinson’s. The palliative care team explains that their job is to support the best physical, emotional and spiritual wellbeing of the immediate family as well as help the family make end of life decisions.

When Is The Right Time For Hospice

Determining when the time is right to consider hospice services can be a difficult decision for the person with Parkinsons, their family and health care providers. Parkinsons, while a chronic and progressive disease, has a course that can be uncertain with no clear indication of the end of life. Yet, those with PD often have additional significant medical problems such as advanced dementia, recurrent pneumonia, weight loss, urinary incontinence, infections and pain that could be better managed through hospice.

Current Medicare benefit guidelines ask health care providers to project that an individual has six months or less to live to enroll in Medicare reimbursed hospice programs. However, many individuals live beyond six months while enrolled in hospice. At the end of the initial six-month period, the hospice agency will reevaluate the care plan and needs of the person with Parkinsons and either re-enroll the individual or discharge the person with Parkinsons from hospice. Patients are discharged from hospice if the individual improves to the point where he/she no longer meets hospice criteria.

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I Decline In Clinical Status Guidelines

These changes in clinical variables are listed in order of their likelihood to predict poor survival, the most predictive first and the least predictive last. No specific number of variables must be met, but fewer of those listed first and more of those listed last would be expected to predict longevity of six months or less.

  • Progression of disease as documented by worsening clinical status, symptoms, signs and laboratory results
  • Clinical Status
  • Recurrent or intractable infections such as pneumonia, sepsis or upper urinary tract.
  • Progressive inanition as documented by:
  • Weight loss not due to reversible causes such as depression or use of diuretics
  • Dysphagia leading to recurrent aspiration and/or inadequate oral intake documented by decreasing food portion consumption.
  • Symptoms
  • Dyspnea with increasing respiratory rate
  • Cough, intractable
  • Nausea/vomiting poorly responsive to treatment
  • Diarrhea, intractable
  • Pain requiring increasing doses of major analgesics more than briefly.
  • Signs
  • Ascites
  • Venous, arterial or lymphatic obstruction due to local progression or metastatic disease
  • Edema
  • Change in level of consciousness
  • Laboratory
  • Increasing pCO2 or decreasing pO2 or decreasing SaO2
  • Increasing calcium, creatinine or liver function studies
  • Increasing tumor markers
  • Progressively decreasing or increasing serum sodium or increasing serum potassium
  • Increasing emergency room visits, hospitalizations, or physicians visits related to hospice primary diagnosis
  • Pharmacologic Issues At End

    Palliative & Hospice Care: Getting the Right Care at the Right Time, Lori Bishop

    As PD progresses there are fewer dopaminergic neurons in the substantia nigra as well as a progressively lower capacity to store exogenous levodopa and convert it to dopamine for storage and release in the remaining neurons. Additionally, as the dose requirements of levodopa increase, the patient’s functioning is inhibited before his next dose of medication . This usually takes place 24 hours after a levodopa dose and may appear as sensory , psychiatric or autonomic symptom, or progression of motor symptoms or dystonia . This is called end of dose wearing off. Wearing off has not been fully explored, but may be connected to pharmacokinetic changes, and shortening of striatal levodopa half-life resulting from progressive degeneration of nigrostriatal dopaminergic terminals . To treat motor symptoms it is necessary to deliver medication effectively. Patients with advanced PD often notice that protein-rich meals will diminish the effectiveness of levodopa doses . This can be alleviated by reducing protein intake during daytime and limiting protein intake at night to 40 grams . There are some strategies to Improve absorption of Levodopa include: advise patients to take levodopa before meals, on an empty stomach , advise patients to avoid protein-rich meals and bulk-forming foods , advise patients against lying down, and encourage them to move around, after ingesting a dose , and advise patients to mix levodopa, crushed into a powder, into sparkling liquid .

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    Support For People With Pd And Their Caregivers

    Understanding the goals and values of patients and their families is the first step in responsive care. The hospice team coordinates care with family members, doctors and facilities to ensure everyone is working together. Support includes:

    • Reducing the risk of infections that may lead to emergency care
    • Managing pain

    How Is Parkinson’s Managed

    There is currently no cure for Parkinsons but there are medications and therapies that can help to manage Parkinsons symptoms.

    Medicines that increase the level of dopamine in the brain are the main treatment used to manage the symptoms of Parkinson’s. Medicines are tailored to each individuals needs.

    Symptoms will get worse when someones Parkinsons medicines are wearing off and improve again after Parkinsons medicines are taken. If people with Parkinsons dont get their medication at the right time, it leads to their motor symptoms becoming uncontrolled. It can take some time to get their symptoms under control again. If you work in a hospital or care home, it is important to be aware that medicine timings will vary from person to person and may be different to ward medicine rounds.

    As well as medicines, surgical options are available for some people with Parkinson’s, depending on their symptoms.

    Treatments can help to manage the symptoms, but may become less effective in the later stages of the condition.

    Parkinsons UK has more information on how Parkinsons affects people and how it can be managed.

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    Patients With Neurological Diseases May Be Eligible For Hospice When They Experience The Following Signs Or Symptoms:

    • Severely compromised breathing, marked by inability to clear respiratory secretions, persistent cough, or recurring aspiration pneumonia
    • Increased shortness of breath, even at rest or on oxygen
    • Inability to swallow liquids or soft food without choking or coughing progression to a mainly pureed diet
    • Spends most of the time in the same room, chair or bed
    • Barely intelligible speech
    • Continued weight loss
    • Inability to manage most activities of daily living

    In addition, patients with neurological diseases become eligible for hospice when they experience continuous decline in clinical or functional status over time, leading to a poor prognosis.

    How Can Hospice Help Your Loved One In The Final Stages Of Parkinsons Disease


    Hospice care is an extra layer of support to help you care for your loved one with end-stage Parkinsons disease. It is a special kind of care that provides comfort, support, and dignity at the end of life.

    The comprehensive program focuses on physical, emotional, and spiritual quality of life through the help of a team of experts. The team includes a board-certified physician, nurse, social worker, certified home health aide , spiritual support counselor, and volunteer.

    The nurse will explain the prognosis and what to expect in the upcoming days or weeks. They will also monitor pain and other symptoms. The CHHA helps with personal care needs like bathing and changing bed linens. The social worker helps address social, emotional and practical challenges including complex and inter-related needs. The spiritual support counselor helps explore spiritual concerns.

    Most importantly, the hospice team will be there for you during this difficult time, bringing you peace of mind. The team is on call 24 hours a day even at 2:00 am.

    Hospice is about making your final months and weeks as good as possible. This means focusing on what really matters to you.

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    Dementia With Lewy Bodies

    Dementia with Lewy bodies typically occurs in individuals over the age of 50 and is characterized by the presence of significant and fluctuating thinking, memory, and attention difficulties .

    Detailed and recurrent visual hallucinations and rapid eye movement sleep behavior disorder are additional core symptoms.

    Both DLB and PD are characterized by the presence of Lewy bodies in the brain. Lewy bodies are abnormal clumps of a protein called alpha-synuclein.

    Other possible symptoms of DLB include:

    • Repeated falls
    • Behavior changes like agitation and aggression

    Patients with DLB also commonly experience parkinsonism , although they are not essential for diagnosis.

    Care Of Patients With Advanced Parkinsons Disease

    Presenting at the UCSF 9th Annual Conference of Parkinsons Disease for Patients and Caregivers, Dr. Maya Katz spoke for 38-minutes about caring for those with advanced Parkinsons disease, including a definition of advanced PD, medication considerations, non-motor symptoms, wellness and exercise, goals of care and taking a supportive care approach.

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    Intercurrent Illnesses Associated With Neurological Disease Include:

    • Pneumonia
    • Upper urinary tract infection or other infection, despite antibiotic therapy
    • Abnormal/absent brain response, verbal response or withdrawal response to pain

    In general, patients who are eligible for hospice are thought to have a prognosis of six months or less if the disease runs its normal course. When improvement is unlikely, or when a decision is made to discontinue a feeding tube or ventilator/breathing support, hospice care should be considered.

    VITAS provides these guidelines as a convenient tool. They do not take the place of a physician’s professional judgment.

    • National Hospice and Palliative Care Organization. . NHPCO Facts and Figures: 2018 Edition.Retrieved from: https://www.nhpco.org/wp-content/uploads/2019/07/2018_NHPCO_Facts_Figures.pdf
    • Parkinsons Foundation. . Understanding Parkinsons – Statistics. Retrieved from: https://www.parkinson.org/Understanding-Parkinsons/Statistics
    • National Multiple Sclerosis Society. . MS FAQs. Retrieved from: https://www.nationalmssociety.org/What-is-MS/MS-FAQ-s
    • Temel, et a. . Early palliative care for patients with metastatic nonsmall-cell lung cancer. New England Journal of Medicine, 363, 733-742.

    Questions To Ask When Considering Hospice:

    Michigan Parkinson Foundation VSG – What is Palliative Care? – June 9, 2020
    • Does the person with PD understand his or her prognosis and health care needs?
    • Does the person with PD want to remain in their current residential setting until the end of life?
    • Has the persons health care provider been consulted in planning for end-of-life care?
    • Is there a living will and/or power of attorney in place for the person with PD?
    • If the person with PD is unable to communicate their wishes for end-of-life care, can someone represent their wishes?
    • How much does the person with PD know about hospice and how does he or she feel about it?
    • Does the person with PD have insurance or is he or she Medicare/Medicaid-eligible for hospice care?

    *Please note that not all content is available in both languages. If you are interested in receiving Spanish communications, we recommend selecting both” to stay best informed on the Foundation’s work and the latest in PD news.

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    Palliative Care For Parkinsons Disease

    Jeffrey Sheung Ching Ng

    Palliative Medicine Physician, Haven of Hope Hospital, Hong Kong, China

    Correspondence to:

    Abstract: Parkinsons disease is a slowly progressive multi-system neurodegenerative disorder, with no available disease-modifying treatment. The disease is associated with motor and non-motor symptoms leading to impaired quality of life, disability and significant caregiver distress. Patients with PD benefit from palliative care which provides a holistic approach to meet their multi-faceted needs, including symptom control, communication needs and caregiver support. This article would review on recent articles addressing palliative care for PD.

    Keywords: Parkinsons disease palliative care prognostication motor symptoms

    Submitted Sep 25, 2017. Accepted for publication Oct 26, 2017.

    doi: 10.21037/apm.2017.12.02

    Types Of Parkinsons Disease

    Parkinson’s disease is a neurodegenerative condition that causes movement-related symptoms like shaking, stiffness, slow movements, and balance problems. These symptoms arise from the death of dopamine-producing nerve cells deep in the brain. Dopamine transmits chemical messages between nerve cells.

    PD is classified into different types based on its cause and age of onset. For instance, idiopathic PD occurs in persons around 60 years of age. Early-onset PD occurs in younger patients, often before the age of 50.

    There are also secondary parkinsonism and atypical parkinsonism. These are conditions that have similar symptoms and signs of PD but are caused by something else, like a drug, stroke, or other primary neurodegenerative disease.

    This article will review the different types of Parkinson’s disease, including causes of secondary parkinsonism and atypical parkinsonism. It will also discuss two conditions that mimic and are possibly related to PD.

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  • If You Live In South Jersey And Have Questions About The Final Stages Of Parkinsons Disease Or Hospice Care For Your Loved One Please Call Samaritan At 229

    Hospice Admission Criteria For Parkinson

    Samaritan is a member of the National Partnership for Healthcare and Hospice Innovation, a network of not-for-profit hospice and palliative providers across the country. If you know someone outside of our service area who is living with advanced illness and can benefit from hospice or palliative care, please call 1 -GET-NPHI for a referral to a not-for-profit provider in your area.

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    What Can Hospice Do For A Patient With A Serious Neurological Disease

    Your hospice team evaluates the patients status and updates the plan of care as symptoms and condition change, even on a day-to-day basis. The goal of hospice is to relieve physical and emotional distress so patients can retain their dignity and remain comfortable.

    Hospice offers comprehensive services for patients with serious neurological disease:

    Palliative Care Management Of Non

    Patients with PD can develop non-motor manifestations, categorized into autonomic dysfunction, cognitive impairment, neuropsychiatric disorders, and sleep disturbances. At the end-stage of PD, non-motor symptoms become more common and can become the most prominent medical problem, leading to increasing decline in quality of life both for patient as well as increasing caregiver burden . Non-motor symptoms occur in up to 50% of PD patients especially in association with the medication off state and may become worse by anti-PD medications . Almost one third of patients reports their non-motor symptoms to be at least as debilitating as their motor symptoms .

    All patients with motor fluctuations face at least one non-motor problem during the off phase . In end-stage of PD, dementia, psychosis, and falls become more complex to manage than the motor complications as a result, managing non-motor aspects is important to increase quality of life and decrease the burden of illness . Chaudhuri and co-workers, using a new 30-item non-motor symptom screening questionnaire , found noticeably high scores among PD patients for impaired taste/smell, impaired swallowing, weight loss, constipation, urinary urgency, forgetfulness, dribbling, sadness, hallucinations, anxiety, sexual dysfunction, falling, reduced concentration, daytime sleepiness, vivid dreams, and sweating .

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