Pulmonary Disease Patients will be considered to be in the terminal stage of pulmonary disease if they meet the criteria of BOTH 1 and 2 with supporting documentation provided by 3, 4 and/or 5. 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 (documen-
         tation of Forced Expiratory Volume in one second (FEV1),
         after bronchodilator, less than 30% of predicted is objective
         to obtain).
b. Progression of end stage pulmonary disease, 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 at rest, as evidenced by oxygen saturation of 88% or less on supplemental O2 (these values may be obtained from recent hospital records). Documentation of the following factors may provide additional support for end stage pulmonary disease: 1. Cor pulmonale or right heart failure (RHF) secondary to
         pulmonary disease (e.g., not secondary to left heart
         disease or valvulopathy)
2. Unintentional progressive weight loss of greater than 10% of
         body weight over the preceding six months
3. Resting tachycardia>100/min.
4. Cyanosis
5. Pursed lip breathing
If a patient meets the medical criteria above, they are by definition eligible to receive hospice services. Some patients may not meet the criteria, but may still be eligible for hospice care due to comorbidities or rapid functional decline. Contact your Samaritan Care Hospice Consultant for further information.