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Hospice Criteria for COPD and Other Lung Diseases

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nurse comforts patient while discussing hospice eligibility for copd and other lung diseasesChronic obstructive pulmonary disease (COPD) is a progressive, debilitating lung condition characterized by difficulty breathing. Pulmonary disease is any respiratory system disorder that presents with symptoms such as coughing, chest pain, shortness of breath, expectoration of blood or mucus, and wheezing or noisy breathing. Diagnostic techniques used to identify pulmonary diseases include bronchoscopy examinations, where healthcare professionals collect secretions and examine them for cytologic or serologic abnormalities, laryngoscopic imaging, lung capacity tests, and radiography.

At Compassus, we understand that hospice criteria for pulmonary fibrosis can be very complex. We offer hospice care to patients with COPD and other lung diseases, such as pulmonary fibrosis, by assessing a patient’s hospice eligibility through an individual assessment process. To learn more about hospice criteria for COPD, contact us at 833.380.9583

Hospice Eligibility for COPD and Other Lung Diseases

For hospice eligibility, the patient must meet certain criteria, including a prognosis of six months or less to live. Other COPD hospice criteria can include the following. 

1. Severe Chronic Lung Disease as Documented by Both A and B

A. Disabling dyspnea at rest, poorly or unresponsive to bronchodilators, resulting in decreased functional capacity, e.g., bed-to-chair existence, fatigue, and cough (documentation of Forced Expiratory Volume in one second (FEV1), after bronchodilator, less than 30% of predicted is objective evidence for severe chronic lung disease, but is not necessary to obtain).

B. Progression of end-stages of pulmonary fibrosis, as evidenced by increasing visits to the emergency department or hospitalizations for pulmonary infections and/or respiratory failure (documentation of serial decrease in FEV1 of greater than 40 ml/year is objective evidence for disease progression, but is not necessary to obtain). 

2. Hypoxemia

As evidenced by the following:

  • Oxygen saturation of 88% or less on room air
  • O2 <= 55 mm Hg

(These values may be obtained from recent hospital records)

Or:

  • Persistent hypercapnia, as evidenced by pCO2 ≥50 mmHg. 

(This value may be obtained from hospital records within the preceding three months)

Documentation of the following factors may provide additional support for end-stage pulmonary disease.

3. Cor Pulmonale or Right Heart Failure (RHF) Secondary to Pulmonary Disease

  • RHF as evidenced by history, physical exam, or EKG

(e.g., not secondary to left heart disease or valvulopathy)

4. Unintentional Progressive Weight Loss of Greater than 10% of Body Weight over the Preceding Six Months

  • Documentation of weight loss (e.g., serial weights)

5. Resting Tachycardia >100/min

If a patient meets the medical criteria above, they are eligible for hospice services. Some patients may not meet the criteria but still, be eligible for hospice due to comorbidities or rapid functional decline. Some resources include:

  • Online BODE index calculator for COPD survival prediction
  • Contact a local Compassus program for referrals or consultation.

Patients will be considered to be in the terminal stage of pulmonary disease if they meet the following criteria: 1 and 2 must be present; factors 3, 4, or 5 provide supporting documentation.

How to Understand Hospice Eligibility for Lung Disease

Understanding hospice eligibility for lung disease can be difficult, especially when dealing with complex medical jargon. The first step is to consult with your doctor and request an extensive evaluation of the patient’s medical history. It’s important to note that certain standard medical criteria must be met to enter a hospice program, such as having a life expectancy of six months or less if their condition doesn’t improve. Don’t hesitate to ask your doctor detailed questions so you can make an informed decision about whether enrolling in a hospice program is the right choice for the patient. With careful consideration and gathering all of the information available, understanding hospice eligibility for lung disease can become more manageable and less overwhelming. 

Learn More About Hospice Criteria for COPD from Compassus

Compassus hospice care teams are here to help you understand hospice criteria for COPD and navigate hospice eligibility for lung disease. We offer personalized hospice services to patients struggling with COPD, pulmonary fibrosis, and other debilitating lung conditions. Our knowledgeable staff is available to answer questions about hospice criteria for COPD. It can provide individuals with the information and support they need to make an informed hospice care decision. Contact us today at 833.380.9583 for more information about hospice eligibility for COPD and other lung diseases.