When caring for loved ones with dementia, when is hospice care the right call?
Hospice care has long been sought out for the comfort and dignity it provides during end-of-life care and the dying process. However, many are unaware that a person does not have to be experiencing excruciating pain or debilitating symptoms in order to take advantage of this form of care. In fact, hospice care is effective for patients suffering from other chronic conditions including heart failure, stroke, liver failure, and even dementia. This article will lay out the standard criteria providers use to evaluate dementia, what some important co-morbidities are, what questions families should ask providers, and why getting hospice care early can be of benefit for both patient and family.
What are some common guidelines regarding dementia and hospice care?
Unlike other serious illnesses, Alzheimer’s disease (AD) and related dementias are extremely difficult to categorize into the stages of progression that are typically used to determine whether hospice care is appropriate. Life expectancy is difficult, if not impossible, to pinpoint for patients affected by AD or other forms of cognitive impairment. Furthermore, patients in the latter stages of these conditions are often unable to communicate pain, discomfort, wants and needs. This means that family caregivers and physicians can have a difficult time deciding when to seek out hospice care.
Because dementia can complicate hospice eligibility, familiarity with hospice guidelines for dementia patients is invaluable. For instance, for a patient to be admitted to a program with a diagnosis of dementia, Medicare requirements are more specific than typical hospice requirements, and involve a six-month life expectancy.
Most programs use the following two criteria to assess if a dementia patient is a candidate for hospice services:
The patient has a stage 7 ranking on the FAST scale.
The Reisberg Functional Assessment Staging (FAST) scale consists of 16 items that rank the progression of dementia symptoms in seven different stages. Stage 7 indicates severe dementia and means a patient is unable to dress, bathe, walk, or use the restroom without help. They may also be unable to speak or express their own thoughts.
Other illnesses exist alongside the patient’s dementia.
Also known as “comorbidities,” these additional health issues are an important part of hospice eligibility. Dementia comorbidities can include sepsis, severe weight loss, or pneumonia. A present comorbidity is often an enrollment requirement and the patient is required to have received treatment for that comorbidity within the last year.
Because those with dementia decline so gradually, family members may not seek help until their loved ones are very close to the end. Many do not realize that assistance and specialized care may have been available much earlier. While a physician must make the official determination of life expectancy, hospice care coordinators recommend requesting a hospice evaluation if an individual with dementia exhibits the following signs:
Constant, elevated levels of anxiety and stress
Complete dependence on others for assistance with activities of daily living, such as eating, bathing, or grooming
Extreme difficulty or complete inability to walk without assistance
The ability to only speak a few intelligible words and phrases