As Hospice eligibility can be complex for those living with dementia, understanding its criteria can be confusing and even when everything possible has been done to predict survival, it can still be hard to know whether someone qualifies.
To assist both patients and their families in deciding if hospice care is suitable, the National Hospice and Palliative Care Organization has issued guidelines. These include a six month prognosis as well as meeting disease-specific LCD guidelines such as Alzheimer’s.
Eligibility for Hospice Care
Dementia patients frequently experience multiple health conditions known as comorbidities that hamper their daily tasks and ability to communicate. Examples may include fever, pneumonia, severe weight loss, sepsis or pressure ulcers – if these issues remain unaddressed it’s unlikely their prognosis would support hospice eligibility.
At present, doctors can only determine hospice eligibility through a clinical assessment which includes both family member and physician evaluation of an individual patient and should include discussion regarding goals, preferences and anticipated time of death.
Unfortunately, dementia patients cannot predict when they will pass due to lack of medical scans and methods to ascertain prognosis. Hospice care can provide invaluable relief during this final chapter by relieving pain while offering more dignified end-of-life experiences for these individuals.
End-of-Life Care
As dementia progresses, patients will require 24 hour care. They will become incapable of bathing themselves, dressing themselves or going to the toilet on their own as well as communicating verbally or with gestures. Bed sores may develop along with infections such as pneumonia.
As a result, family caregivers will quickly become worn out and depressed; primary caregivers can even experience burnout. Furthermore, it may be challenging for family caregivers to ascertain when their loved one is experiencing discomfort; late-stage dementia patients frequently exhibit behavioral changes, including aggression and agitation, that indicate untreated discomfort.
Related Article: What Cause Amnesia?
Hospice services consist of a team of healthcare professionals such as physicians, nurses, counselors, social workers and aides that offer comfort to a person at the end of life – including physicians, nurses, counselors, social workers and aides. Hospice professionals will assist the person physically, emotionally and spiritually as they near death.
It may be appropriate for physicians to discuss whether it’s time for them to discontinue taking certain medication such as cholinesterase inhibitors which slow progression but do not significantly improve quality of life.
Related Article: 7 Stages of Lewy Body Dementia
Hospice Care for Dementia Patients
Given dementia’s unpredictable progression, it can be challenging to predict their end-of-life care needs accurately, making early discussion about hospice essential. To provide them with optimal comfort during their final months.
An evaluation will take place with dementia patients to determine their eligibility for hospice services, either at their home, hospital or assisted living facility.
At present, nearly half of older adults on hospice have dementia; this proportion is rapidly expanding; thus necessitating reevaluation of criteria for hospice eligibility.
For a better understanding, please review the table below called Hospice Criteria for Dementia.
What is Hospice Criteria For Dementia?
In order to establish whether or not a patient is in the final phase of dementia’s illness, it is necessary to ascertain whether or not they match at least one of the following criteria: What Are the Hospice Criteria for Dementia?
1) Dependence on assistance for daily activities,
2) Inability to communicate
3) Limited life expectancy.
If a patient meets one of these criteria, they must also meet either criterion 2 or 3.
1. Dementia’s disease reaches its terminal stage when a patient reaches stage 7 on the FAST scale and meets criteria A, B, and C. Additional factors offer additional credence to terminal status:
- All understandable vocabulary lost
- Incapable of keeping the head up
- Non-ambulatory Patients are unable to walk or bear their own weight.
- Incontinence
- incapacity to speak meaningfully (one to five words per day).
- Unable to sit unaided without assistance, unable to muster a grin
2. Functional impairment will be influenced positively or negatively depending on the presence of co-morbid diseases and terminal illness. The consequences of Dementia’s disease, in conjunction with those of any co-morbid condition, should be sufficient to establish a prognosis of fewer than six months.
- Renal failure
- Cancer
- CHF stands for congestive heart failure.
- Disease of the liver
- Neurological disease
- Chronic obstructive pulmonary disease is what the letters COPD refer to in full.
3. Patients must have been diagnosed with at least one of the following secondary diseases within the previous 12 months:
- Septicemia
- Delirium
- Infections that come back or are difficult to treat, such as pneumonia or another type of URI or pyelonephritis, or another type of urinary tract infection
- Aspiration pneumonia
- Decubitus ulcers, many stages 3-4
- Fever that comes back after taking antibiotics repeatedly
- Incapacity to maintain an adequate intake of fluids and calories, as evidenced by either of the following: 10% of total body weight lost in the most recent six months
When it comes to dementia-related medical requirements, a patient is considered qualified for hospice care if they satisfy all of the abovementioned requirements. Even if a patient does not satisfy all of the requirements, they may still be eligible for hospice care if they rapidly lose their functional abilities or other conditions.