Hospice care by condition
Hospice care for ALS, Parkinson's and related illnesses
Yes. People with ALS, Parkinson's disease and related neurological illnesses can receive hospice when a doctor certifies eligibility. The two illnesses move very differently. ALS usually advances over months to a few years, and breathing and swallowing drive the decisions. Parkinson's often advances over many years, and the late stage brings falls, swallowing trouble, infections and sometimes dementia. Hospice helps with both at home.
Reviewed by our medical director, September 24, 2026
On this page (7 sections)
Two illnesses, two different paths
| ALS | Parkinson's disease | |
|---|---|---|
| Usual pace | Steady loss of muscle strength over months to a few years. | Slow change over many years, often with a faster decline near the end. |
| What drives hospice decisions | Breathing muscles weaken. Swallowing and speech become hard. Choices about breathing machines and feeding tubes come up. | Medicines work less well. Falls, swallowing trouble, pneumonia, weight loss and, for many people, memory and thinking changes. |
| Thinking and memory | Most people stay clear-minded. Some develop changes in thinking or behavior. | Dementia and hallucinations are common late in the illness. |
| What families often say | "Her mind is all there, but her body is not." | "He has had this for years, but this year is different." |
ALS: signs it may be time to talk with the doctor or a hospice nurse
These are reasons to ask. They are not a verdict:
- Short of breath at rest, when lying flat, or while talking or eating
- Using a breathing mask (BiPAP) for more and more hours of the day
- Choking or coughing with food, drink or saliva, or a pneumonia from swallowing trouble
- Losing weight, and deciding for or against a feeding tube
- Needs help with nearly all care, and the change has come quickly over recent months
- The person has decided against a tracheostomy and breathing machine, or wants to stop one
Parkinson's and related illnesses: signs it may be time to ask
This list also fits related illnesses such as progressive supranuclear palsy, multiple system atrophy, Lewy body dementia and late-stage multiple sclerosis or Huntington's disease:
- In a bed or chair most of the day and needs help with nearly all care
- Frequent falls, or too stiff or frozen to move safely even with medicines
- Choking, coughing at meals, or pneumonia more than once
- Eating little and losing weight
- More confusion, hallucinations or sleepiness, and medicines cannot be adjusted without side effects
- Repeated infections, pressure sores or hospital stays in recent months
If this sounds familiar, ask the neurologist or the ALS or movement disorder clinic whether hospice should be part of the conversation, or talk with a hospice nurse. General signs for any illness are in is it time for hospice?.
How hospice helps with ALS and Parkinson's
| Problem | How the hospice team helps |
|---|---|
| Breathlessness and fear of choking (ALS) | Medicines that ease air hunger and anxiety, kept in the home with clear instructions. Positioning, a fan, suction when it helps, and a nurse to call at any hour. |
| Saliva, secretions and swallowing | Medicines that reduce saliva, mouth care, and teaching on safer comfort feeding. Support for the feeding tube decision either way. |
| Stiffness, cramps and pain | Pain and muscle medicines, gentle positioning, and equipment such as a hospital bed when it is part of the plan of care. |
| Parkinson's medicines | The team works with the neurologist to keep comfort-focused Parkinson's medicines going while the person can swallow, and plans for when they cannot. Some common nausea and agitation medicines make Parkinson's worse, and the team knows which to avoid. |
| Confusion, hallucinations, restless nights | A calm routine, checking for causes such as infection or pain, and careful use of medicines. |
| Losing speech | Time and patience, yes and no signals, letter boards, and working with any speech device the person already uses. |
| Caregiver exhaustion | Hospice aide help with bathing, social work, chaplain support if wanted, and respite care for up to 5 days at a time. |
The exact services and equipment depend on the person's needs and the plan of care. See what hospice provides.
Breathing machines and hospice in ALS
Many people with ALS use a BiPAP mask to rest the breathing muscles. Using one does not rule out hospice. Tell the hospice nurse what equipment is in the home so the plan of care can address it.
Some people choose a tracheostomy and a breathing machine. Others decide they do not want one, or decide later to stop. These are the person's choices to make. If someone chooses to stop a breathing machine, the hospice team and doctor plan ahead so that medicines for comfort are given first and the family is supported.
Put these wishes in writing early, while speech is still easy. See advance directives and POLST in California.
What families ask
When should someone with ALS start hospice?
There is no single moment. Many families ask when breathing becomes hard at rest, when swallowing is unsafe, or when the person decides against a breathing machine. Asking early does not commit you to anything. A doctor decides whether the person is eligible.
Does Parkinson's disease qualify for hospice?
It can. Parkinson's itself moves slowly, so doctors look at the whole picture: how much help the person needs, swallowing, weight loss, infections and dementia. Only a doctor can certify eligibility.
Will hospice stop the Parkinson's medicines?
Not as a rule. Medicines that keep the person comfortable and able to move usually continue as long as the person can swallow them. The hospice doctor and the neurologist review the list together with you.
Can he keep seeing his neurologist?
Yes. You can name your own doctor as the attending physician, and the hospice team works with them. Ask us how visits to a specialist fit with the hospice plan of care before you schedule them.
What if we are not ready for hospice?
Palliative care can help with symptoms at any stage, alongside regular treatment. See hospice and palliative care compared.
Who pays?
Medicare covers hospice care related to the terminal illness. Under Medicare, most people pay nothing for hospice care itself. Medi-Cal covers hospice, and most private plans include a hospice benefit. See paying for care.
For doctors and other clinicians
Clinical indicators for ALS, including respiratory and nutritional findings, are in our ALS eligibility guide for professionals.
About this page
- Written by
- Beta Hospice care team
- Clinically reviewed by
- our medical director
- Last reviewed
- September 24, 2026
- Next review
- March 24, 2027
How we write and review this site
Sources
- National Institute of Neurological Disorders and Stroke: Amyotrophic lateral sclerosis (ALS) (opens in a new tab)
- National Institute of Neurological Disorders and Stroke: Parkinson's disease (opens in a new tab)
- Medicare.gov: Hospice care coverage (opens in a new tab)
These sources support the general information on this page. For one personās care and coverage, talk with the hospice team.
You do not have to decide alone.
Call (909) 347-7000 any time, or leave your number and someone from Beta's hospice team will call you. No decision is needed to call. Most families start with a question.
Only a hospice doctor, together with the personās own doctor, can confirm hospice eligibility. A website cannot.
- A nurse answers 24 hours a day, 7 days a week
- You can stop hospice at any time
- You have the right to choose your hospice