Hospice Eligibility: End-Stage COPD and Other Forms of Lung Disease

Hospice eligibility guidelines for COPD and lung disease are: 

Major characteristics

• Dyspnea at rest or with minimal exertion 
• 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

Other important critical factors

• Cor pulmonale
• Continuous chronic oxygen therapy
• Resting tachycardia > 100/minute
• Steroid-dependent
• Cyanosis

Abnormal laboratory findings

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 Appropriateness: 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)

• Emphysema
• Chronic bronchitis

• Chronic asthma
• Bronchiectasis
• 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