Stroke or Coma Patients will be considered to be in the terminal stage of stroke or coma if they meet the following criteria: BOTH 1 and 2. 1.Poor functional status with a Palliative Performance Scale (PPS) of 40. See appendix: a. Primarily bedbound
b. Unable to do work
c. Requires maximal assistance to perform self-care
d. Food/fluid intake are normal/reduced
e. Either fully conscious or drowsy/confused
2. Inability to maintain hydration and caloric intake with ONE of the following: a. Weight loss>10% during previous 6 months
b. Weight loss>7.5% in previous 3 months
c. Serum albumin<2.5 gm/dl
d. Current history of pulmonary aspiration without effective
         response to speech language pathology interventions
         to improve dysphagia and decrease aspiration events
e. Calorie counts documenting inadequate caloric/fluid intake
If a beneficiary does not meet both medical criteria #1 and #2, the documentation should describe a relevant comorbidity and/or rapid decline. The medical criteria listed below would support a terminal prognosis for individuals with a diagnosis of coma (any etiology). Comatose patients with any 3 of the following on day three of coma are considered terminal: a. Abnormal brain stem response
b. Absent verbal response
c. Absent withdrawal response to pain
d. Serum creatinine >1.5 mg/dl
Medical complications for long-term comatose patients may include: 1. Aspiration Pneumonia
2. Sepsis
3. Recurrent fever after antibiotics
4. UTI
5. Stage 3-4 decubitus ulcers
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.