It’s difficult for physicians to determine with precision how long a patient with a terminal illness can expect to live. But, it’s particularly challenging when the patient is also suffering from advanced dementia. Medicare requires a physician to certify that the patient entering hospice has a life expectancy of six months.
Doctors typically recommend hospice when a patient faces cancer or heart failure — which have more predictable trajectories. However, when patients with advanced dementia receive a referral, they’re often enrolled quite late. According to a study led by The Journal of General Internal Medicine, “Fewer than 1 in 10 people suffering from dementia receive hospice services.”
It’s unfortunate because dementia patients can greatly benefit from symptom control, specialized care and family support hospice offers. Today, we’ll be discussing hospice care for patients with dementia along with its entry criteria and symptom management.
Giving Dementia Patients Access to Hospice in the Earlier Stages of Their Illness
Family members often don’t recognize dementia as a terminal illness. It’s seen as a neurological disorder rather than something that affects one’s physical health. However, studies have found that people suffering from advanced dementia frequently endure the same pain and shortness of breath as traditional hospice patients.
A better prognosis can lead to less suffering for dementia patients. It’s better to explore a loved one’s qualifications now than waiting until the final months of their terminal illness. There’s no specific number of symptoms a patient must exhibit. However, in order for a dementia patient to be eligible for hospice, he or she must have a life expectancy of six months or less.
If you’ve started seeing your loved one’s health decline in addition to advanced dementia, it may be time to consider hospice. Here are some signs to look for:
- A diagnosis of lung or heart failure, cancer or other terminal diseases
- An increase in hospitalizations or frequent trips to the doctor
- Difficulty swallowing or choking on liquids/food
- Unable to walk or sit upright without assistance
- Consistent, elevated levels of anxiety and stress
- Speech is limited to a few intelligible words or phrases
- Depends on assistance for daily activities like eating, bathing and grooming
The Criteria Used to Admit Dementia Patients Into Hospice
For a dementia patient to be admitted into hospice, Medicare has stricter requirements involving a 6-month life expectancy. Most hospice programs will use the following standards when assessing whether hospice care for patients with dementia is appropriate.
Typically, a dementia patient will be ranked stage 7 on the Functional Assessment Staging (FAST) scale. The FAST scale ranks the progression of dementia symptoms using 16 items. At stage 7, a patient is suffering from incontinence and depends on the assistance of a caregiver for eating, walking, bathing and dressing. In this stage, patients also have difficulty expressing their thoughts.
Other illnesses in addition to dementia play an important role in the patient’s eligibility for hospice. A comorbidity is often an enrollment requirement. The most common comorbidities include sepsis, severe weight loss, pneumonia, pressure ulcers and fever. If a comorbidity is present, the patient is required to have received treatment within the last year.
As you can see, determining eligibility for dementia patients can be difficult for physicians. However, with families, hospice teams and Medicare working together, we can ensure dementia patients receive proper care.
Dementia Symptom Management
A hospice provider will create an individual plan of care to see the needs of the patient. For those living with dementia or Alzheimer’s disease, the hospice team will provide medical care to help alleviate symptoms while assisting caregivers in maintaining the patient’s dignity.
Medication pertaining to the patient’s diagnosis and supplies such as hospital beds and wheelchairs are included in the Medicare hospice benefit. Additionally, the hospice provider employs a team of specialists to provide education and support to family caregivers. This also includes assistance in arranging respite care or bereavement support.
When to Contact Hospice For Your Loved One
Due to the progression of dementia, it can be difficult for families to determine when a loved one becomes eligible for hospice care. Starting the conversation early means you’ll have more time to gather information and develop a plan of action.
Our experienced team at McCortney Family Hospice is happy to meet with your family at a time and place that’s most convenient for your loved one. To arrange a consultation and further discuss the hospice care for patients with dementia, reach out to us today at (405) 360-2400 in Norman or (580) 332-6900 in Ada.