Hospice care by condition
Hospice care for ALS
Yes. People with ALS (amyotrophic lateral sclerosis) can receive hospice when a doctor certifies eligibility. ALS usually advances over months to a few years, and breathing and swallowing drive the decisions: when to use a breathing mask, whether to have a feeding tube, and whether to accept a tracheostomy and a breathing machine. Hospice fits when breathing is hard at rest, swallowing is unsafe, or the person has decided against a breathing machine. Parkinson's disease moves differently and has [its own page](/conditions/parkinsons/).
Medically reviewed by Oscar Chien, MD, Medical Director, October 19, 2026
On this page (5 sections)
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
If this sounds familiar, ask the neurologist or the ALS 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
| Problem | How the hospice team helps |
|---|---|
| Breathlessness and fear of choking | 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. |
| 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.
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. Parkinson's disease and the related disorders are on their own page.
About this page
- Written by
- Beta Hospice care team
- Medically reviewed by
- Oscar Chien, MD, Medical Director
- Last reviewed
- October 19, 2026
- Next review
- April 19, 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)
- Medicare.gov: Hospice care coverage (opens in a new tab)
These sources support the general information on this page. For one person鈥檚 care and coverage, talk with the hospice team.
You do not have to decide alone.
Call (877) 258-7129 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 person鈥檚 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