Hospice Care for Alzheimer’s Disease / Dementia patients is key to improving the patient’s quality of death, decreasing end-of-life care burdens for families and nursing home staff, and saving Medicare and Medicaid money.
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What Is Alzheimer’s and Dementia?
Alzheimer’s disease is a degenerative brain disease and the most common form of dementia. Dementia is not a specific disease. It’s an overall term that describes a group of symptoms.
Hospice Care for End-Stage Alzheimer’s Disease / Dementia
Alzheimer’s Dementia is a progressive neurologic disease that affects an estimated 5.5 million patients in the United States. It is an unbearably difficult disease for patients and families alike. We all have patients who are caregivers to a parent or spouse with this ugly disease, and know how challenging it can be.
Hospice for Alzheimer’s disease is a covered Medicare service that allows patients to die with dignity. It also provides added family/caregiver support, volunteer services and bereavement counseling. A hospice care taker is a gift to every end-stage Alzheimer’s patient.
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Patient Eligibility for Hospice Care in End-Stage Alzheimer’s Disease
Patient must have a severity of dementia of a Reisberg’s Functional Assessment Staging (FAST) scale of 7C or higher. The FAST score is a way to estimate how advanced the Alzheimer’s is. To have a FAST score of 7C, the patient should meet the following criteria:
- Can’t walk without assistance
- Can’t dress without assistance
- Can’t bathe without assistance
- Bowel and bladder incontinence
- Can’t speak more than 6 intelligible words/day or no meaningful verbal communication
Also, the patient should have had one of the following comorbid conditions in the last 6 months:
- Aspiration Pneumonia
- Multiple progressive stage 3-4 decubiti
- Fever after antibiotics
- Unable to maintain fluids/caloric intake to sustain life: weight loss of 10% of body weight in 6 months and /or albumin less than 2.5gm/dl.
The following general changes that indicate a worsening will support the end-stage diagnosis:
- Infection (UTI, URI, cellulitis)
- Uncontrolled pain or other symptoms
- Psychosocial issues
- Hypotension with systemic BP less than 90 or postural hypotension, edema, ascites, pleural/pericardial effusion and weakness
And therefore, the provider should assess the patient and if the criteria above are met, consult hospice. Hospice has aides that will come in to help with bathing, nurses that help with medications and comfort, volunteers that may bring a pet or a musical instrument, chaplains to provide spiritual support and bereavement specialists to help the family with the death.
At last, the hospice team can also be integral in helping the families decide to make the patient a “do-not-hospitalize” or “do-not-resuscitate” patient, and this is crucial in end-stage Alzheimer’s. The goal should be comfort, not treating to prolong a life whose quality is incredibly bereft. Repeated hospital stays to treat dehydration, aspiration pneumonia and urinary tract infections are very expensive for the insurance company, but more importantly, are devastating for the end-stage Alzheimer’s patient who may become delirious and would probably be much more at peace in his or her friendly bed at home. The hospice gift is a blessing to the patient and the family. And it is a gift to Medicare and Medicaid as well, because the patient will not continually be sent back and forth to the hospital for infections, increasing costs and utilization. Please consider giving the gift of hospice.
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Get more general alzheimer’s disease / dementia hospice care information from Alzheimer’s Association here.