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HomeHealthWhat Qualifies A Dementia Patient For Hospice

What Qualifies A Dementia Patient For Hospice

How Do Dementia Patients Eventually Die

Hospice: Dementia Eligibility

Its commonly thought of as fatal medical conditions for people with Alzheimers disease late in their disease stages. It is often a deadly infection that contributes to dementias death if an immune system has been suppressed. Acute conditions in immobility may cause blood clots even if you prevent an infection.

When Should You Call Hospice For Dementia Patients

Determining when to begin hospice care can be challenging for dementia patients as the disease does not follow a clear progression the way many other illnesses do.

Patients in end-stage dementia tend to require around-the-clock help with daily living. They lose awareness of their surroundings and recent experiences and have greater difficulty communicating.

To meet hospice eligibility criteria, hospice patients must have a life expectancy of six months or less if their disease follows its typical progression.

Although there is no set number of symptoms patients with dementia must show to be eligible, the following may be signs that it is time to consider hospice.

  • Increasing hospitalizations and visits to the doctor or emergency room
  • A diagnosis of pneumonia, sepsis, cancer, COPD, CHF or congenital heart disease alongside dementia
  • Weight loss or dehydration that is connected to trouble eating and drinking
  • Difficulty sitting upright or walking without assistance
  • Trouble swallowing or frequently choking on foods or liquids
  • Very limited speech
  • Urinary and fecal incontinence

What Can Hospice Do For The Family Of A Patient With Dementia

Family members may have to make difficult healthcare and financial decisions, act as caregivers and provide emotional support to others. If the decision is made to stop medical support, families often experience strong emotions and feel overwhelmed.

Hospice offers comprehensive services for families of patients with dementia:

Caregiver education and training The family caregiver is vital in helping hospice professionals care for the patient. As the patient gets weaker, symptoms increase and communication becomes more difficult. We relieve families concerns by educating them on how best to care for their loved one.

Help with difficult decisions Hospice helps families make tough choices that impact the patients condition and quality of lifefor example, whether to give antibiotics for a recurring infection.

A VITAS nurse by phone 24/7 Even the most experienced caregivers will have questions and concerns. With Telecare®, they dont have to wonder, worry or wait for an answer. As the heartbeat of VITAS after hours, Telecare® provides trained hospice clinicians around the clock to answer questions or dispatch a member of the team to the bedside.

Emotional and spiritual assistance Hospice meets the needs of loved ones along with those of the patient.

Respite care Caring for a loved one with an end-stage illness can cause tremendous stress. Hospice offers up to five days of inpatient care for the patient in order to give the caregiver a break.

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Does Medicare Cover Hospice For Dementia

Although it is a gut-wrenching choice, youve decided to admit your senior parent or loved one to hospice for dementia care. One of your chief concerns now is how youll pay for it. Can Medicare cover the costs?

Possibly, yes. According to the Alzheimers Association, if both your seniors physician and the medical director at the hospice center have confirmed that the patient meets the hospice eligibility criteria, then Medicare should cover the costs of hospice.

Should your senior parent or loved one already have Medicare Part A, then theyd be eligible for coverage as well.

Alzheimers Association elaborates on the medical and support services a dementia patient can receive while in hospice:

  • Prescription medications
  • Nursing care
  • Doctor care

Be aware that if your loved one with dementia needs symptom control or pain-relieving medications, you could be charged a copay for these medications. This would only be up to $5, says the Alzheimers Association. Hospice services wouldnt cost you anything though.

There may be some caregiver support available to you as well. Respite care is a good example. Under respite care, hospice patients who are still in their own homes may be eligible for hospital stays from several days to a month or more. This allows you to rest, knowing that your loved one is being well taken care of by the hospice care teams. Be sure to ask the social workers assigned to your loved one for more information about potential supportive care for you.

What Stage Of Dementia Qualifies For Hospice

Hospice Eligibility for People With Dementia

In order for a dementia patient to meet the hospice eligibility criteria, he or she must have a life expectancy of six months or less if the disease continues in its typical progression. For patients with dementia, it may be time to consider hospice when the patients physical condition begins to decline.

Read Also: Difference Between Senility And Dementia

How Long Do Dementia Patients Live On Hospice

Lets say the dementia patient in your life was given a doctors prognosis of six months. Once theyre in hospice care, is there a possibility they could live longer?

Yes, but more than likely, it wont happen. Thats only because, as we said before, dementia is progressive.

Although its possible that your loved one could have been in the middle stages of dementia for several years, once they reach the third stage of the disease, their body begins shutting down. At this point, the end of life is not far off.

If they can barely get food or drink down without choking and theyre speaking very infrequently, those are also signs that the disease has advanced quite rapidly.

In the last days and weeks of their lives, a dementia patient will usually experience these symptoms:

  • Breathing changes, such as very fast breathing for a few seconds, then slower and shallower breaths, followed by faster ones
  • Barely being able to stay awake and even being unconscious instead of asleep
  • Restlessness
  • Cold legs, arms, feet, and hands

Its worth mentioning that not every dementia patient follows these stages to the letter. Their symptoms might appear sooner or later than what is common, but many dementia patients generally experience the same symptoms at the end of their life. Thats how the FAST Scale was able to be developed.

Three Points About Hospice According To Medicare

  • To qualify for hospice care, a hospice doctor and your doctor must certify that youre terminally ill, meaning you have a life expectancy of 6 months or less.
  • When you agree to hospice care, youre agreeing to comfort care instead of care to cure the illness.
  • You also must sign a statement choosing hospice care instead of other benefits Medicare covers to treat the terminal illness and related conditions.
  • One of the services hospice provides is respite care for the family caregiver.

    Especially when caring for someone with dementia or Alzheimers, the mental, emotional and physical toll on the caregiver can be enormous, making respite for the caregiver essential.

    Here are four things to know about respite care through hospice:

  • Depending on the terminal illness and related conditions, the plan of care the hospice team creates can include inpatient respite care, which is care provided in a Medicare-approved facility , so that the usual caregiver can rest.
  • Your hospice provider will arrange this for you.
  • Patient transport is included and you can stay up to 5 days each time you get respite care.
  • You can get respite care more than once, but only on an occasional basis.
  • For more information about paying for care, check this video by Author Cameron Huddleston.

    Dementia is a disease with no cure so it qualifies as terminal, which qualifies a dementia patient for hospice. But how then is life expectancy predicted?

    May you find joy in loving one another well.

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    Does Hospice Provide Care For Dementia Patients

    Hospices goal is to alleviate physical, mental, and emotional distress that leads patients to go through what is referred to assecond shock. Patients with dementia have access to comprehensive services available fromHospice individualized care plans patients lose the ability to express themselves as they go through dementia.

    Dementia Due To Alzheimers Disease And Related Disorders

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    Note: This section is specific for Alzheimers Disease and related disorders, and is not appropriate for other types of dementia, such as multi-infarct dementia.

    Patients will be considered to be in the terminal stage of dementia if they meet the following criteria. Patients with dementia should show all the following characteristics:

  • Stage seven or beyond according to the Functional Assessment Staging Scale
  • Unable to ambulate without assistance
  • Unable to dress without assistance
  • Unable to bathe without assistance
  • Urinary and fecal incontinence, intermittent or constant
  • No consistently meaningful verbal communication: stereotypical phrases only or the ability to speak is limited to six or fewer intelligible words.
  • Fever, recurrent after antibiotics
  • Inability to maintain sufficient fluid and calorie intake with 10% weight loss during the previous six months or serum albumin < 2.5 gm/dl.
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    Is Dying Of Dementia Painful

    People with advanced dementia often do not receive all their care in the final moments even after theyre suffering from a number of ailments, including respiratory or urinary infections, fatigue, a nervous shock, depression, as well as sometimes a burdensome transition from one activity to another. A decrease in symptom burden is possible when you treat it with pharmacists, pharmaceuticals, or nonopioids.

    For Primary Care Physicians

    Crossroads Hospice & Palliative Care is your partner in providing support to patients with late-stage Alzheimers 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 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 patients home environment and alerting you to any changes in the patients condition.

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    Palliative Care In Advanced Dementia

    • 1Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
    • 2Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf , Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
    • 3Clinical Trials Center , Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
    • 4Center for Health Services Research, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany

    Is Hospice Good For Dementia Patients

    Programs  Pathway Hospice

    Since dementia is progressive, the symptoms might start off manageable enough, but there will be a slow decline and worsening cognitive impairment over time.

    That brings us to hospice.

    Hospice, if you need the definition, is end-of-life care for someone who has a terminal illness. Is this really the right option for a dementia patient or are they better off in a nursing home or an assisted living facility?

    Hospice programs are absolutely an appropriate choice if your senior has advanced dementia. Through around-the-clock professional medical care by the hospice team, your parent or loved one will recover some quality of life in their last months.

    The quality of life for family caregivers will improve as well. There is a lot of emotional stress that goes along with worrying about a loved one all the time.

    As we mentioned in the intro, they could be partaking in dangerous activities such as trying to leave the house in the middle of the night or turning on the stove. Whats worse is they dont even realize what theyre doing.

    Youll still be able to regularly visit your parent or loved one while theyre in hospice, but their care will no longer be a worry or burden for you to bear.

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    Dementia Is Highly Unpredictable

    A challenge for family caregivers of dementia patients is that dementia can be highly unpredictable, compared with diseases such as cancer. The federal Centers for Medicare and Medicaid Services has established a life expectancy component to guide physicians in prescribing hospice care for dementia.

    If the family of a dementia patient doesnt immediately qualify for the full range of hospice services, caregivers still have options available. Among 4,700 local hospice programs in the United States, some offer bridge or transition programs that provide some form of hospice service. Caregivers may inform doctors and other health care providers regarding levels of treatment to forestall unnecessary tests and procedures.

    Also, caregivers may take part in advanced directives for end-of-life medical procedures, to the point of pursuing a formal do not resuscitate order.

    Bottom line: When in doubt, family caregivers should contact their local hospice program.


    When It Is Time For Hospice

    Dorothys family was agreeable to her admission to hospice. Although her home care team provided excellent care, the family still preferred the addition of in-home hospice, because it added a level of care and support for both her and her family. In Dorothys situation, she could stay where she was and hospice care would come to her. Her caregivers of many years would also remain with her.

    Exactly how does one qualify for hospice? Under Medicare Part A guidelines, hospice eligibility must include the following three conditions:

    • Your loved ones physician or nurse practitioner, and the hospice physician, certify that your loved one is terminally ill that is, they are within the last six months of life.
    • You accept palliative care for your loved one which is care for their comfort, versus care to cure their illness.
    • You choose hospice care for your loved ones terminal illness, and sign a statement documenting your choice.

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    Medicare Guidelines For Hospice Dementia

    Dementia patients eligible for Medicare coverage receive annual wellness checkups as part of their preventative care plan.

    If a person gets dementia, the coverage assists with the expenditures associated with the disease throughout its course. In the final months of life, hospice care is included in this plans benefits.

    Dementia patients eligible for Medicare hospice benefit must have a life expectancy of six months or less if the disease progresses at its normal rate of progression. When a patients physical condition begins to deteriorate, hospice care may be an option to explore.

    Medicare assists with services that a person diagnosed with dementia needs at each condition stage. An outline of Medicares dementia coverage is provided in the following paragraphs.

    Hospice For Dementia Patients

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    Despite its benefits, hospice is underutilized for advanced dementia patients. End-of-life prognostication presents a significant barrier to hospice usage.

    Hospice has been shown to help dementia patients and their families. Dementia patients who died with hospice vs. those who died without hospice have better pain control, are less likely to die in a hospital, and their families have greater satisfaction with end-of-life care, says Susan Mitchell, MD, senior scientist at the Institute for Aging Research, Hebrew SeniorLife in Boston.

    Hospice offers patients and their families support and care from an interdisciplinary team composed of experts in end-of-life care. Hospice team members are knowledgeable about common problems and symptoms that may occur in patients with advanced Alzheimer’s.

    Family members and the affected individual need to be comfortable with nurturing what remains of the affected persons function, says Roger A. Brumback, MD, a professor of pathology, psychiatry, and neurology at Creighton University School of Medicine in Omaha, Nebraska. Simultaneously, they need to adjust to the diminished capacity and the end stages of life. Hospice can help with this.”

    However, If hospice can prove eligibility and document continued decline, patients may remain on hospice longer, says Mary-Ann McCue, RN, BSN, CHPN, hospice manager for the Norwell Visiting Nurse Association and Hospice in Massachusetts.

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    Hospice Care For Dementia Patients

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    It is reported that dementia patients who get hospice have a better pain control, are less likely to die in a hospital setting, and have families who are more satisfied with the care they receive. In hospice care, one of the main goals is to have pain and symptoms controlled as best as possible. We believe that by relieving our patients pain and symptoms as much as possible we will be ensuring a better quality of life for them. As an example, some of the symptoms which we treat are as follows:

    • restlessness and confusion
    • Depression
    • Altered nutrition

    Patients as well as their families and caregivers could benefit greatly from hospice care, as it can limit these transitions between healthcare providers and improve quality of life. In addition to offering family caregivers the needed support near the end of life, hospice care helps them cope with their grief, both before and after their family member passes away, regardless of whether it is provided at home or in a facility.

    Complex Interventions In Advanced Dementia

    As people with advanced dementia suffer complex symptoms and still have numerous and complex physical, psychosocial and spiritual needs they are in need of multidisciplinary health care. By comparison with early stages of the disease there is less knowledge about needs in advanced dementia . Physical needs are related to adequate symptom relief and basic care needs. It is complex to meet the numerous and differentiated psychosocial needs comparable to people in moderate state of dementia, e.g., need of enhancing personhood, communicating and being in contact with others, participating in everyday life or feeling save and familiar . Unmet social needs for activity contributed to discomfort and behavioral symptoms . Needs being important in mild or moderate stage of the disease, e.g., financial needs and cognitive strategies for coping with disease are less direct needs at least for the people with advanced dementia themselves.

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