Hospice Criteria for Dementia Such as Alzheimer’s.

Over 5 million Americans are currently living with Alzheimer’s disease and related dementias, with more than 15 million family caregivers providing unpaid support. Understanding hospice eligibility for Alzheimer's/dementia is crucial for these families, as it helps determine when their loved one can receive specialized care hospice offers.

In the early stage of Alzheimer’s disease, individuals may experience memory lapses, such as misplacing items or struggling to find the right word or name. While they can still function independently, they begin to have increasing difficulty with planning and organization.

As the disease progresses to the moderate or middle stage, individuals require more assistance. Memory loss becomes more severe, and confusion sets in. Some may need help remembering to dress appropriately for the weather, and changes in sleep patterns and personality are common. This stage often lasts the longest, spanning several years.

In end-stage dementia, known as Stage 7 on the Functional Assessment Staging (FAST) Scale, individuals require round-the-clock assistance with daily tasks. They lose awareness of recent events and their environment, and communication becomes severely impaired. Those in late-stage Alzheimer’s are also more susceptible to infections, particularly pneumonia. Caregivers must anticipate the needs of their loved ones during this stage, as they may forget basic functions like how to suck from a straw or swallow.

Alzheimer’s and other dementias progress slowly, making it challenging for families to recognize when their loved one qualifies for hospice care. To be eligible, a patient must have a life expectancy of six months or less if the disease follows its typical course. While there is no definitive list of symptoms that guarantees hospice eligibility, understanding common signs of advanced dementia can help families decide when it’s time to explore hospice options. Reviewing these symptoms can provide guidance in making this important decision.

Limitation in activities of daily living.

As dementia progresses, many individuals face significant challenges in performing basic daily tasks, often signaling hospice eligibility. Some common limitations include:

Inability to move, walk, or sit upright without support
Needing help with dressing
Inability to bathe independently

Speech limited to six words or less per day

Loss of bladder and bowel control
No longer able to smile

Additional complicating conditions.

Dementia patients in advanced stages may develop additional medical conditions that further compromise their health. Some common complications include:

Aspiration pneumonia: A lung infection caused by inhaling food, liquid, or saliva into the lungs
Pyelonephritis or upper urinary tract infections: Severe kidney or bladder infections
Septicemia: A life-threatening bloodstream infection resulting from infections in other parts of the body
Decubitus ulcers (bedsores): Multiple deep pressure sores, often in stage 3 or 4, indicating severe tissue damage
Recurrent fever after antibiotics: Ongoing fevers that persist despite antibiotic treatment, suggesting an underlying infection or immune response issue
Delerium: Sudden confusion or changes in mental status, often caused by infections, dehydration, or other underlying health issues

Nutritional deficiencies.

As dementia progresses, maintaining proper nutrition becomes increasingly difficult, and certain signs indicate a serious decline in health:

Difficulty swallowing or refusing to eat
For those on artificial nutritional support (via NG tube, G-tube, or TPN), continued weight loss despite feedings
Inability to sustain adequate fluid and calorie intake, shown by weight loss exceeding 10% or more over six months, BMI below 18, or serum albumin levels under 3.1

Presence of co-morbid conditions.

Certain underlying health conditions can further impair the health and functionality of dementia patients, accelerating their decline. These include:

Medicare hospice criteria for dementia and Alzheimer’s.

To qualify for hospice care under Medicare, an individual must be enrolled in Medicare Part A and be certified by a physician as terminally ill, with a prognosis of six months or less if the illness follows its normal course. View more information at the Code of Federal Regulations part 418 or the Centers for Medicare and Medicaid Services Hospice Pre-Election Evaluation.

Dementia symptom management. 

Crossroads Hospice & Palliative Care creates an individual interdisciplinary plan of care, integrating key dementia and Alzheimer's hospice criteria to address the unique needs of each patient. For patients living with Alzheimer’s disease or other dementia, our team provides medical care to alleviate symptoms including pain and anxiety and personal care to assist caregivers in maintaining the patient’s dignity at end-of-life.

Medication related to the patient’s primary diagnosis and medical supplies such as incontinence products, hospital beds and wheelchairs are included in the hospice benefit at no charge to the patient or family. These items will be delivered as needed to the patient, eliminating the need to run to the pharmacy or to research medical supply providers.

In addition, our team of emotional and spiritual support specialists provide education and support to family caregivers. This includes volunteers to sit with the patient so family members can take a break without worrying about the patient’s safety and assistance in arranging respite care. Our staff can also assist families with end-of-life planning, making funeral arrangements and bereavement support.

For the patient already receiving care in a memory care unit or other long-term-care facility, Crossroads Hospice & Palliative Care is available to partner with the facility to provide an extra layer of one-on-one care and attention. This includes providing complementary therapies and activities to supplement the clinical and personal care the patient receives such as reading or playing music for the patient, foot massages, or aromatherapy.

Our goal is to provide an enhanced quality of life for patients with end-stage Alzheimer’s disease or other dementias that meet the above hospice criteria, making the most of lucid moments and ensuring the patient is comfortable and free of pain even when they are no longer able to communicate their needs.

For primary care physicians.

Crossroads Hospice & Palliative Care is your partner in providing support to patients with late-stage Alzheimer’s disease or other dementias. We can admit new patients 24 hours a day, 7 days week. Plus our expert staff of pain and symptom management professionals will work with you, the patient, and their family to make the transition to hospice as easy as possible.

Does your patient not meet the hospice criteria for Alzheimer’s or other forms of dementia? You may want to consider palliative care. Our palliative care team works side-by-side with physicians to treat symptoms and side effects, alleviate pain, and address family questions and concerns. Our team provides regular reports to the primary care physician, providing you with an extra set of well-trained eyes and ears in the patient’s home environment and alerting you to any changes in the patient’s condition.

When to call hospice.

Due to the slow progression of these conditions, it can be difficult for family members to determine when a patient becomes eligible for hospice care. This is why the conversation about hospice should happen early on. This way you have a plan in place should the hospice eligibility criteria be met for Alzheimer’s or other dementias.

Crossroads Hospice & Palliative Care is available to assess the patient in their home environment (meaning their home, a hospital, assisted living facility etc.) to determine whether they meet the hospice care requirements for dementia. We are happy to meet with families at the time and place most convenient for them.

To arrange a hospice consultation, please contact us at 855-327-4677 . Our team is available 24 hours a day to take your call.

Ready to refer a dementia patient?

If you're a healthcare professional ready to refer a dementia patient for hospice care, please submit a patient referral form online. Our dedicated team is here to provide support and guidance throughout the referral process.