Hospice Eligibility: End-Stage COPD and Other Forms of Lung Disease
Download a PDF of these guidelines.
Are you a patient, family member, or caregiver? Learn about how VITAS can help patients with end-stage COPD and other forms of lung disease.
Hospice eligibility guidelines for COPD and lung disease are:Major characteristics
- Dyspnea at rest and/or with minimal exertion while on oxygen therapy
- Dyspnea unresponsive or poorly responsive to bronchodilator therapy
- Progression of chronic pulmonary disease as evidenced by one or more of the following:
- Frequent use of medical services, including hospitalizations, ED visits and/or physician outpatient visits, due to symptoms of pulmonary disease
- Frequent episodes of bronchitis or pneumonia
- Unintentional weight loss of ≥ 10 percent body weight over the preceding six months
- Progressive inability to independently perform various activities of daily living (ADLs) or an increasing dependency with ADLs, resulting in a progressively lower performance status
- Cor pulmonale
- Continuous chronic oxygen therapy
- Resting tachycardia > 100/minute
While these laboratory studies may be helpful to the clinician when considering patient appropriateness for VITAS services, they are not required for patient admission.
- FEV1 ≤ 30 percent predicted post-bronchodilator
- Serial decreases in FEV1 of at least 40 ml/year over several years
- PO2 ≤ 55 on room air
- O2 sat. ≤ 88 percent on room air
- Persistent hypercarbia (PCO2) ≥ 50 mm HG
VITAS provides these guidelines as a convenient tool. They do not take the place of a physician's professional judgment.
Hospice Clinical Eligibility: End-Stage COPD and Other Forms of Lung Disease
Physicians may use clinical guidelines to identify patients in the final six months of lung disease. When it comes to end-of-life care, patients should be both physiologically and psychologically hospice-appropriate.
Hospice care is designed to help patients who:
- Are dyspneic at rest or with minimal exertion
- Have progressed to the point where they spend most of their days at home
- Have experienced repeated ED visits (one or more each quarter) due to infection or episodes of respiratory failure
- Have endured repeated hospitalizations (one or more each quarter) and no longer wish to be admitted
- No longer wish to be intubated
VITAS counsels patients and their families about their goals and alternative ways to manage symptoms to prevent unwanted hospitalization and intubation.
Types of nonmalignant, life-limiting, chronic lung diseases:
- Chronic obstructive pulmonary disorder (COPD)
- Chronic bronchitis
- Chronic asthma
- Pulmonary fibrosis
- Cystic fibrosis
- End-stage tuberculosis
Specialized Hospice Program for Patients with End-Stage COPD and Other Lung Diseases
Dyspnea and the anxiety it causes are two of the most distressing symptoms that patients experience. These can often be treated using a combination of clinical therapies and the individual, 24-hour support that hospice offers. The VITAS plan of care for end-stage lung disease includes:
- Comprehensive evaluation by all members of the interdisciplinary team
- Pre-emergency care planning consistent with the patient’s needs and goals
- Pharmacologic and non-pharmacologic interventions to reduce episodes of respiratory distress
- 24-hour response upon onset of respiratory distress using a customized emergency protocol
- Caregiving objectives focused on improving the patient's quality of life