Hospice Criteria for Parkinson's Disease

Parkinson's disease is a degenerative disorder of the central nervous system affecting the way one moves. The problem develops due to damage of certain nerve cells in the brain and disorder manifests are characterized by muscle rigidity, slowing of physical movement, tremors and in severe cases, loss of physical movement.

Dopamine is a chemical that is made by the nerve cells responsible for sending signals to the motor control part of your brain, allowing your muscles to operate smoothly and to move as you tell them to. With Parkinson's, the nerve cells break down and trouble begins. Parkinson's is a progressive disease; however, it does advance slowly. Medications are available to help treat the disease, but oftentimes, in the end, the medication is no longer effective and the disease takes over the patient.

Advanced Parkinson's

• Parkinson's gradually increases showing itself through advanced disorder ailments such as autonomic dysfunction, axial signs, neuropsychiatric problems and sleep disorders all of which are common in the advanced stages of Parkinson's. These symptoms will show themselves as urinary disturbances, depression and anxiety, dementia, freezing, dysarthria or ostural instability and insomnia.

  Some of the drugs used to treat Parkinson's cause hallucinations, and for the patient suffering from dementia, increased episodes are often experienced.

  Progression of Parkinson's also causes tremors of the limbs. Arm mobility begins to disappear and a sufferer is no longer capable of swinging the arms. The body begins to lean forward and the patient loses the ability to rise from a chair or roll over in bed. Facial expressions disappear as the dophamine receptors no longer can tell the face to react, or send emotions. Aggression and depression tend to become severe.

  In many patients with the late stages of Parkinson's swallowing becomes impossible as the patient no longer remembers how to swallow.

Caring for the Patient with Parkinson's

• Parkinson's is a long-term disease and as the disease goes on, emotions run higher. This is a commitment that can lead to depression, exhaustion, guilt and stress. The best advice for caring for the Parkinson's patient is:

  1. Get help.
  2. Get family involved.
  3. Help educate those around you on Parkinson's.
  4. Maintain your own health.
  5. Don't hold things inside.
  6. Laugh.
  7. Know there is help.

  There are millions of families in the U.S. caring for someone with Parkinson's and many depending on community services or those provided by the Parkinson's Association. The Parkinson's Association is a great outlet for help in the care of the patient for both present and long term.

When It's Time for Hospice and Hospice Eligibility

• Parkinson's becomes debilitating in the end and as the illness progresses into its final stages caring for the patient may be something that the family member or caregiver can no longer accomplish alone. Reading the guidelines for hospice for the Parkinson's patient may help you to decide if hospice is an alternative that you should seek.

  To be eligible for hospice the patient must meet certain criteria. The patient must have critically impaired breathing with each of the following:
  1. Dyspnea while resting
  2. Vital capacity of less than 30 percent
  3. Supplemental oxygen at night required
  4. Artificial ventilation declined by the patient

  OR
  Rapid disease progression with:
  1. Insufficient intake of nutrients and fluids to sustain life
  2. Continual weight loss
  3. Dehydration or hypovolemia
  4. No artificial feeding methods

  OR
  The patient must have life-threatening complications such as:
  1. Recurring aspiration pneumonia (with or without tube feedings)
  2. Upper urinary tract infection
  3. Sepsis
  4. Recurring fever after antibiotic therapy
  5. Stage 3 or 4 pressure ulcers

Hospice Referral

• Referral for the Parkinson's patient for hospice care does not need to be done by the patient's physician. The initial referral can be made by anyone. This includes family or friends. However, the Hospice Program will contact the patient's physician before actual admission to the program to verify that the patient is eligible for hospice care.

  Once the eligibility has been determined, by law, the final decision is the patient's.

Insurance Coverage and Hospice

• Medicare Part A provides coverage for all expenses involved in the hospice care. A patient can also be covered under Medicaid. Most private insurance plans and HMOs as well as other managed care organizations provide coverage.