Hospice Care Admission Guidelines for Parkinson’s Disease

LCD Guidelines

Parkinson’s Disease

(At least one of the following criteria must be satisfied)

Severely compromised respiratory function, as evidenced by all of the following:
- Shortness of breath (dyspnea) at rest
- Vital capacity below 30%
- Need for supplemental oxygen while at rest
- Patient refuses artificial ventilation

Rapid disease progression coupled with either A or B:
- Loss of independent mobility, resulting in wheelchair or bedbound status
- Speech deterioration, progressing from clear to barely intelligible or unintelligible
- Transition from a regular diet to a pureed diet
- Loss of independence in daily living activities (ADLs), now requiring significant assistance from a caregiver for all ADLs

AND

A: Severe nutritional decline, evidenced by all of the following in the past 12 months:

Oral intake of food and fluids is insufficient to sustain life
Continued weight loss
Dehydration or hypovolemia
Refusal or absence of artificial feeding

B: Life-threatening complications, as demonstrated by one or more of the following in the past 12 months:

Recurrent aspiration pneumonia (with or without tube feeding)
Upper urinary tract infection (e.g., pyelonephritis)
Sepsis
Recurrent fever despite antibiotic treatment
Stage 3 or 4 pressure ulcers

In the absence of these criteria, rapid decline or the presence of comorbid conditions may further support eligibility for hospice care.

Comparative Data

Fast Score: Upon admission, the patient was at Fast 7a, but has now progressed to Fast 7c.

PPS/ADL: Initially admitted with a PPS score of 50%, the patient’s PPS has now decreased to 40%.

Intake: Previously eating 100% of their meals, the patient is now consuming only 50%, with instances of food pocketing. The diet has shifted from regular to pureed, and the patient, who once ate independently, now requires prompts to complete meals.

Weight Loss: The patient has lost 10 pounds since admission.

Alertness/Orientation: Initially sleeping 10 hours a day, the patient now sleeps over 15 hours daily and has become combative during care, requiring medication to manage behaviors.

Skin Condition: Skin assessments should be done during each visit. Redness is now observed on the coccyx, whereas no skin issues were previously reported.

Mobility: The patient, who could independently move in a wheelchair upon admission, is now unable to do so and leans in the chair, requiring lateral support.

Infections: There have been occurrences of new or recurring infections.

Fever: The patient has been experiencing recurring fevers.