Patients are considered to be in the terminal phase of coma or stroke if they meet these criteria:
Criteria one and two are key signs of nutritional and functional status and support a terminal prognosis for individuals who have diagnosis of stroke. Number three lends support.
1. Poor functional status along with a Palliative Performance Scale of <40 . All criteria in #1 must be met:
- Either drowsy/confused or fully conscious
- Fluid/food intake are reduced/normal
- Requires maximal help to conduct self-care
- Incapable of working
- Mainly bed-bound
2. Incapability of maintaining caloric and hydration intake with 1 of these:
- Dysphagia serious enough to prevent an individual from receiving fluid/food that’s needed to sustain life in a person who doesn’t get artificial hydration/nutrition.
- Calorie counts document inadequate fluid/caloric intake.
- Present pulmonary aspiration history without efficient reaction to speech language pathology interventions that improve dysphagia and reduce events of aspiration.
- Serum albumin
- Weight loss greater than 7.5 percent in previous three months
- Weight loss greater than 10 percent during previous six months
3. Documentation of health complications in the previous year, in the context of progressive medical decline, will assist in supporting hospice care eligibility.
- Intractable or recurrent infections like pneumonia or additional URI
- Refractory stage 3 to 4 decubitus ulcers
- Fever recurrent following antibiotics
The clinical criteria listed below could support a terminal prognosis for patients who have a diagnosis of coma. Comatose individuals who have any 3 of the following on day 3 of coma are considered terminal:
- Serum creatinine greater than 1.5 mg/dl
- Absent withdrawal reaction to pain
- Absent communication
- Abnormal brainstem reaction
If an individual meets the aforementioned clinical criteria, they’re qualified to obtain hospice services. Some individuals might not meet the criteria, yet may still be qualified for hospice due to rapid functional decline or comorbidities. Call Saad Healthcare at (251) 343-9600 for further details on our hospice care services and assessment information.