When To Start Hospice For A Loved One With Alzheimer’s Disease

As our loved ones with Alzheimer’s Disease progress in their illness, we may ask at what point it would be advisable to enlist the help of hospice. Hospice enrollment provides access to 24/7 care and support via regularly scheduled and as-needed nurse visits in person and by telephone.

In Medicare’s own words – A hospice care team is assembled to attend to “the ‘whole person,’ including physical, emotional, social, and spiritual needs.”

In addition to nurses, hospice team members typically include social workers, chaplains, and home health aides who assist with bathing and grooming. Hospice providers also employ doctors who can direct care should a patient’s own physician or nurse practitioner choose to no longer fill that role. Other benefits include the provision of prescription drugs and medical equipment such as walkers and hospital beds. In addition, the Medicare hospice benefit allows for short-term inpatient respite care to afford caregivers the opportunity for needed rest.

To be eligible for hospice admission, a patient must be diagnosed with a life-limiting illness with an expected prognosis of six months or less. Alzheimer’s Disease has been determined to be a qualifying diagnosis when certain criteria are met. Medicare guidelines place The Reisberg Functional Assessment Staging (FAST) scale front and center in establishing eligibility. The FAST scale maps the progressive activity limitations associated with Alzheimer’s Disease which proceed from inability for self-care such as bladder and bowel control to loss of speech and mobility.

At the same time, a co-occurring condition such as coronary heart disease, congestive heart failure, or COPD may also be contributing to the activity limitations already associated with Alzheimer’s Disease. Secondary conditions that stem directly from such activity limitations and/or the disease process itself will likewise be taken into consideration.

Medicare guidelines specifically mention delirium and pressure ulcers, but as a hospice admissions nurse I routinely ask patients and families about:

  • falls
  • visits to the ER
  • infections such as UTIs and pneumonia
  • decrease in appetite and food and fluid intake
  • difficulties swallowing
  • weight loss
  • increased daytime and nighttime sleeping

All of these are indications used to paint a complete picture of eligibility with respect to a patient’s prognosis. 

Ultimately, following Medicare guidelines, it is the hospice medical director (along with the patient’s primary care practitioner when available) who is responsible for certifying a patient’s qualification for hospice service. Patients can be re-certified for hospice care as long as the hospice medical director can document continued decline. Should a patient’s decline plateau, a patient will be discharged due to an extended prognosis but will be eligible again should evidence of decline reemerge. 

In my experience as a hospice nurse, it was an enormous relief for families to know they could expect regular nurse visits and be able to call with any questions at any time – day or night. Hospice care helps ensure that a loved one is as comfortable as they can be. Each individual moves through dementia in their own unique way, but there are common aspects that those who work in hospice are intimately familiar with. In that way, hospice nurses are in the best position to educate and reassure patients, their families, and caregivers alike.

If you have questions about applying for Medicare’s hospice program, please reach out to us for a geriatric telemedicine consultation or contact us. We’ll do our best to answer your questions and help guide you on receiving hospice care for your loved one.

Marc Goodman RN

Marc Goodman, RN Geropsych Nurse

Before becoming a registered nurse at age 50, Marc was a stay-at-home dad, brand producer for an educational software company, co-owner of a record store, a bookstore clerk, and a restaurant worker. Since graduating, he’s worked as a psychiatric nurse in different settings and as a hospice nurse at Casa de la Luz for five years.

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