Hospice Eligibility Guidelines for Individuals with Dementia & Alzheimer’s

We understand that navigating the complexities of hospice care can be overwhelming, especially when dealing with dementia. This page aims to provide you with a comprehensive guide to the eligibility guidelines for hospice care specifically designed for individuals facing dementia.

Dementia diagnoses may include:

• Alzheimer’s Disease
• Dementia with Lewy Bodies (DLB)
• Vascular Dementia
• Parkinson’s Disease Dementia
• Huntington’s Disease
• Other Dementia Forms

Disease Specific Guidelines

Patients who meet the following criteria will be deemed to be in the terminal stage of dementia, with a life expectancy of six months or less if the illness runs its course. These criteria apply to patients with different forms of advanced dementia who ultimately follow a final common pathway for end-stage disease. The patient should show all of the following characteristics:

1. Stage seven or beyond according to the Functional Assessment Staging Scale
2. Inability to ambulate (move/walk) without assistance
3. Inability to bathe without assistance
4. Inability to dress without assistance
5. Fecal and urinary incontinence, constant or intermittent
6. Lack of consistently meaningful verbal communication (speech limited to six or fewer intelligible words or only stereotypical phrases.

Patients should also have had one of the following in the preceding twelve months:

1. Inability to maintain sufficient nutrition and hydration with 10% weight loss during the previous six months or a serum albumin <5gmdl
2. Aspiration pneumonia
3. Pyelonephritis or other upper urinary tract infection
4. Septicemia
5. Decubitus ulcers (pressure injuries), multiple, stag 3-4
6. Fever, recurrent following antibiotics

Non-Disease Specific Guidelines

1. Physiologic impairment of functional status demonstrated by a score < 70% using either:
   1. Karnofsky Performance Status (KPS)
   2. Palliative Performance Score (PPS)
2. Dependence on assistance for two or more of the following activities of daily living (ADLs):
   1. Feeding
   2. Bathing
   3. Dressing
   4. Toileting
   5. Ambulation (walking/moving)
   6. Transfer

Co-morbidities

Although not the primary hospice diagnosis, the presence of certain co-morbidities should be considered in determining hospice eligibility, as the severity of these conditions is likely to contribute to a life expectancy of six months or less. These co-morbidities may include:

• Chronic obstructive pulmonary disease
• Congestive heart failure
• Ischemic heart disease
• Dementia
• Renal failure
• Diabetes mellitus
• Liver disease
• Acquired immune deficiency syndrome (AIDS)
• Neurologic disease (CVA, ALS, MS, Parkinson’s)
• Neoplasia

Disclaimer: Please note that the information provided on this page is intended for general guidance purposes only and should not replace professional medical advice. Each individual’s situation is unique, and eligibility for hospice care should be assessed by qualified healthcare professionals.

 

Benefits of Hospice Care for Individuals with Dementia and Alzheimer’s Disease:

Hospice care offers numerous benefits tailored to the specific needs of individuals with dementia. Some of these benefits include:

1. Pain and Symptom Management: Hospice care focuses on alleviating pain and managing distressing symptoms associated with dementia.

For those with dementia and Alzheimer’s Disease this may include managing symptoms commonly experienced which may include:

• Cognitive decline
• Sleep disturbance
• Agitation
• Anxiety
• Weakness and fatigue
• Pain
• Decreased nutrition and weight loss
• Assistance with difficulty swallowing

The interdisciplinary team, including physicians, nurses, respiratory therapists, social workers, and chaplains, work together to develop a comprehensive plan that addresses the unique needs of each patient. For resources on managing a loved one’s pain, click here.

2. Medication and Equipment Support: Hospice provides medications and other necessary equipment related to managing the symptoms that may arise with dementia. This ensures that patients have access to the resources they need to maintain comfort and improve their quality of life. All medications and durable medical equipment related to the terminal condition are covered under the hospice benefit. With dementia this may include mobility aides, a hospital bed, thickener for drinking liquids, and more.

3. Emotional and Psychosocial Support: Hospice care extends support not only to patients but also to their families and caregivers. Helping a loved one with dementia can be challenging. Social workers and counselors are available to provide emotional support, counseling, and resources to cope with the challenges that arise during this difficult time. The nursing team is available to assist in educating and guiding you through providing the best care to your loved one with dementia.

4. Skilled Nursing Care: Hospice care includes skilled nursing services provided by specially-trained hospice nurses who have expertise in managing the complexities of Alzheimer’s disease and dementia. These skilled nurses assess and monitor the patient’s condition, provide anticipatory guidance based on disease progression, educate the patient and caregivers, manage medications, provide wound care if needed, and collaborate with other healthcare professionals to ensure comprehensive care.

5. Assistance with Activities of Daily Living (ADLs): Nurse aides, also known as certified nursing assistants (CNAs), are an integral part of the hospice team. They provide hands-on assistance with activities of daily living (ADLs), such as bathing, dressing, grooming, and toileting. For individuals with dementia and Alzheimer’s disease who may experience fatigue and physical limitations due to disease progression, nurse aides help maintain personal hygiene, promote comfort, and preserve dignity.

6. 24/7 Access to Care: Hospice care offers round-the-clock access to the hospice team, providing peace of mind for patients and their families. This availability ensures that assistance is available whenever it is needed, even outside regular office hours.

7. Spiritual and Bereavement Support: Hospice care acknowledges the importance of spiritual and emotional well-being during end-of-life care. Chaplains or spiritual counselors are available to provide spiritual support, and bereavement services are offered to help families cope with grief and loss after the passing of a loved one.

8. Self-guidance: An individual is allowed to receive care in their preferred setting and have input on their care allowing for an increased sense of comfort.

For more information about our services, click here.

Not sure if you or a loved one are eligible to receive hospice care?

Contact the Honor Hospice team for an evaluation to determine if hospice is an appropriate care option.