Multiple Sclerosis – Eligibility for Hospice Care

Hospice care provides specialized care and support for individuals with a terminal illness, such as Multiple Sclerosis. It addresses the physical, emotional, and spiritual needs of the patient and their family, and can be provided in the patient’s home or in a hospice facility. Eligibility for hospice care is determined by a medical evaluation and Medicare guidelines. Hospice care provides physical comfort, emotional and spiritual support, and family support to those facing the end of life.

Key Points

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Written By
Matthew Snyder


Multiple sclerosis (MS) is a chronic, progressive disease that affects the central nervous system. It is characterized by the damage and scarring of the myelin sheath that surrounds and protect nerve fibers in the brain and spinal cord. This damage disrupts the normal communication between the brain and the rest of the body, leading to a wide range of symptoms that can vary greatly from person to person.

MS is a debilitating and life-changing condition that can have a significant impact on the lives of patients and their families. As the disease progresses, patients may experience a decline in their physical and cognitive abilities, making it increasingly difficult to perform daily activities. In the final stages of MS, patients may require significant assistance with their care and may experience significant pain and discomfort.

What to Expect During the Final Stages of Multiple Sclerosis

As multiple sclerosis progresses, patients may experience a decline in their physical and cognitive abilities, making it increasingly difficult to perform daily activities. In the final stages of MS, patients may require significant assistance with their care and may experience significant pain and discomfort.

The progression of MS can vary greatly from person to person, but common symptoms experienced by MS patients in the final stages include:

  • Muscle weakness: MS can cause damage to the nerve fibers that control muscle movement, leading to weakness and difficulty with mobility.
  • Fatigue: MS can cause a general feeling of exhaustion and fatigue, making it difficult to perform daily activities.
  • Difficulty with coordination and balance: MS can affect the ability to coordinate movements and maintain balance, making it difficult to walk or stand.
  • Difficulty with speech and swallowing: MS can affect the nerves that control speech and swallowing, making it difficult to communicate or eat.
  • Bladder and bowel problems: MS can affect the nerves that control the bladder and bowel, leading to incontinence or constipation.
  • Pain: MS can cause a variety of pain symptoms such as spasticity (muscle stiffness and spasms) and trigeminal neuralgia (pain in the face).

In addition to these symptoms, patients in the final stages of MS may also experience:

  • a decline in cognitive function, such as difficulty with memory, attention, and problem-solving.
  • emotional changes, such as depression and anxiety.
  • decreased mobility and independence, which can lead to a loss of independence and isolation.

The final stage of MS is not well defined, and there is no specific time when it begins. However, patients are considered to have reached the final stage of MS when they have severe disability and require constant care. This can be a difficult time for both patients and their families, as they may need to adjust to a new way of life and make difficult decisions about care.

It is essential to consult a doctor or healthcare provider who has expertise in MS and is familiar with the patient’s specific case. Hospice care can be considered an option when the patient reaches the final stages of the disease, and the healthcare provider can guide the patient and their family through the process of determining hospice eligibility.

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Eligibility for hospice care for patients with Multiple Sclerosis

Medicare Guidelines

When it comes to determining hospice eligibility for MS patients, there are specific criteria that must be met. These criteria include:

  • The patient has critical nutritional impairment evidenced by:
    • Oral intake of nutrients and fluids insufficient to sustain life
    • Continuing weight loss
  • Rapid disease progression or complications in the preceding

12 months as evidenced by:

  • 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
  • Progression from independent in most or all activities of daily living (ADLs) to needing major assistance by caretaker in all ADLs
  • Life-threatening complications in the preceding 12 months as evidenced by one or more of the following:
    • Critically impaired breathing capacity
    • Dyspnea at rest
    • The requirement of supplemental oxygen at rest
    • The patient declines artificial ventilation
    • Recurrent aspiration pneumonia (with or without tube feedings)
    • Upper urinary tract infection (pyelonephritis)
    • Sepsis
    • Recurrent fever after antibiotic therapy
    • Stage 3 or 4 decubitus ulcers
  • A physician may determine that a patient has a life expectancy of six months or less even if the above findings are not present.

It is important to note that these are the general criteria for hospice eligibility and each individual case may be evaluated differently. Additionally, co-morbidities such as other chronic illnesses can also support a patient’s eligibility for hospice care.

How Hospice Care Can Assist

Hospice care can assist MS patients in the final stages of their disease in the following ways:

  • Pain and symptom management: Hospice care providers can work with patients to manage their pain and other symptoms, such as fatigue, difficulty with mobility, and difficulty with speech and swallowing. They can also provide medication and other treatments to help alleviate these symptoms.

  • Emotional and spiritual support: Hospice care providers can offer emotional and spiritual support to patients and their families during this difficult time. This includes providing counseling and support groups, as well as connecting patients and their families with chaplains or other spiritual leaders.

  • Care coordination: Hospice care providers can coordinate the patient’s care, working with the patient’s primary healthcare provider and other specialists to ensure that all of the patient’s needs are met. They can also help the patient and their family navigate the healthcare system and access resources such as financial assistance.

  • In-home care: Hospice care providers can provide in-home care to patients who wish to remain at home. This can include providing nursing care, assistance with activities of daily living, and coordinating care with other healthcare providers.

  • Respite care: Hospice care providers can also provide respite care, which is short-term care for patients so that their primary caregivers can take a break.

It is important to speak with an experienced hospice care provider when considering this option. They can help the patient and their family understand the benefits and limitations of hospice care and make an informed decision about their care. They can also assist with determining hospice eligibility and help navigate the process of enrolling in a hospice program.

About The Author

Matthew Snyder

Matthew Snyder

Meet Matthew, a healthcare professional with over 10 of experience in the medical field. With a passion for improving end-of-life care, Matthew brings a wealth of knowledge and expertise to Hospice Report. Matthew has worked in a number of strategic marketing roles at some of the largest healthcare networks globally and brings a unique perspective on the future of patient care.

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