Question on End Stage Parkinsons

[pmabraham, BSN, RN]

Question on End Stage Parkinsons

Problem Statement:  Over the past 4.5 years between two separate hospice agencies there has been a pattern of admitting patients for Parkinsons Disease where the result is frequent discharges for failure to decline.  For every four admissions, approximately one patient dies within six to nine months.

For those that were hospice appropriate, I've worked with both ends of the spectrum where on one end the patient became so stiff they had trouble breathing, were on oxygen, were only oriented to self and was complete care including feeding to the other end of the spectrum where they would have spells of looking as if they were on a horse trying to throw them off, and when they were not having such severe tremors that medications could no longer manage, they could partially participate in self-care such as feeding themselves.

Quick Flips doesn't list specifications for End Stage Parkinsons and from researching Medicare briefly describes the following:

·         Rapid disease progression

·         Progression from independent ambulation to wheelchair or bed-bound status

·         Progression from normal to barely intelligible or unintelligible speech

·         Progression from normal to pureed diet

Yet for the patients I've had that fit, the only thing true as been the wheelchair or bedbound status.  All the patients that died within the expected time period went through normal disease progression vs. rapid (it was rapid in the last three months, but not rapid in the preceding three), did have intelligible speech, and only progressed in diet in the last month.

Therefore, question: Can any of you provide details as to what your admission team (whether one person or many) look at specifically to ensure that a patient being admitted for End Stage Parkinsons is most likely going to die in at least one year after admission?  I.e. how can we all be more accurate in admitting Parkinson patients when they are in the terminal stage?

Thank you.

[vampiregirl, BSN, RN]

Parkinson's patient's can be tricky to accurately assess if they meet the life expectancy criteria of 6 months or less if the disease process takes it's normal course!

Some of the considerations our team presents to our providers in order for them to make eligibility determination:

• Significant co-morbidities
• Significant/ progressive decline in past several months
• Any recent infections in past 6-12 months
• Weight loss in past several months, BMI, current intake, dysphagia?
• PPS 
• ADL status
• FAST Score if appropriate