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

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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 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

Hospice Admission Guidelines for Patients with End-Stage COPD or Other Lung Diseases

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 of the patient to independently perform the 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.

Download a PDF of these guidelines:

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