When Is An Alzheimer Patient Ready For Hospice

Hospice For Alzheimers Patients

Alzheimers disease is a difficult illness both for the patient and their loved ones. Home hospice care can provide support as the end of life approaches. At Omni Care Hospice, we are pleased to provide compassionate end-of-life care in Las Vegas. Call us at 509-5276 if you have any questions regarding hospice care for late-stage Alzheimers patients.

How Might Dementia Affect People Towards The End Of Life

Dementia is progressive, which means it gets worse over time. In the last year of life, its likely to have a big impact on the persons abilities including memory, communication and everyday activities. The speed at which someone will get worse will depend on the type of dementia they have and who they are as an individual.

The symptoms of later stage dementia include the following:

A person with later stage dementia often deteriorates slowly over many months. They gradually become more frail, and will need more help with everyday activities such as eating, dressing, washing and using the toilet. People may experience weight loss, as swallowing and chewing become more difficult.

A person with later-stage dementia may also have symptoms that suggest they are close to death, but continue to live with these symptoms for many months. This can make it difficult for the person and their family to plan for the end of life. It also makes it difficult for those supporting them professionally.

For more information on supporting someone with later stage dementia see Alzheimers Society factsheet, The later stages of dementia .

Does Your Loved One Have Secondary Conditions That Are Contributing To Their Physical Decline

Your loved one may have physical conditions or other chronic diseases that must be dealt with along with Alzheimers. As their mental abilities decline, this becomes more and more challenging. In a Hospice environment, attention is given to all areas of patient needs.

At Crown Hospice in Cape Girardeau, MO, we specialize in caring for the unique needs of Alzheimers patients. As your loved ones condition changes, we are here to provide the help, care, and support they need.

Please call 703-4801 , or 335-4800 today and discuss your loved ones needs with one of our counselors.

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Is Your Loved One Unable To Speak Intelligently Due To Alzheimers Disease

Gradually, Alzheimers patients lose their ability to find words, follow conversations, and express their own thoughts. During the middle stages of the disease, their ability to communicate may decline so severely that your loved one is unable to speak intelligently. This difficulty may make caring for your loved one impossible without the support of a Hospice environment.

Support Their Cultural And Spiritual Needs

Its good to be aware of the persons cultural and spiritual needs and make sure these are respected and supported. You can make use of any advance care plans or documents, friends and family input and your knowledge of the person. Its important to try and meet these needs as much as possible, they are just as important as medical care.

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When Should I Ask For Support

Supporting people with dementia at the end of their life requires a team approach. Often, there will be many people involved in the persons care at the end of their life. Good communication and information sharing helps to ensure the person receives the care they need.

If youre unsure about anything or have any concerns seek advice from a colleague, manager or another health care professional.

There may be certain professionals who can advise on specific issues. These may include a GP, district nurses, social workers, other care staff and specialists.

Hospice Care Offered To Alzheimers Patients

Hospice care is intended for individuals with a life expectancy of six months or less, so patients with Alzheimers disease or other forms of advanced dementia must meet the criteria to qualify for care. It can be hard to assess when the end of life will occur since the disease progresses at different rates for each patient, so families should begin the conversation about hospice care with a doctor when the patient begins to enter the later stages of Alzheimers disease.

Families caring for a loved one with advanced dementia who has a life expectancy of six months or more may benefit from palliative care even if the person doesnt yet qualify for hospice services. Palliative care works in conjunction with treatment directed by a health care provider, so the patient can continue to treat Alzheimers or other concurrent diseases while receiving support services.

Respite care is another option for family members caring for an Alzheimers patient. This type of care is intended to give a short break to family caregivers. In some cases, coverage for hospice care, palliative care and respite care may be covered by Medicaid, Medicare or private insurance, so check with your provider to see if coverage is available.

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For Patients Speaking To Families

Education is key. Educate yourself first. By now, youve probably done some research on this website. It might also be helpful for you to learn some common misconceptions about end-of-life care, as your family may be misinformed about the realities of hospice. View our video on dispelling hospice myths. Read and share “Considering Hospice: A Discussion Guide for Families” at HospiceCanHelp.com

Determine what your loved ones know. Before bringing up hospice, make sure your loved ones have a clear understanding of your health status. People handle difficult information in different ways. If family members are not accepting or understanding of your prognosis, you might want to have your physician, clergy or a trusted friend speak with them on your behalf.

Discuss your goals for the future, as well as theirs. As a patient, your greatest concern might be to live without pain, or to stay at home, or to not become a burden. Ask your loved ones what their concerns are when they consider the coming months, weeks and days. Explain that hospice is not giving up. It is an active choice to ensure that everyones needs are met.

Take initiative. Remember, its up to you to express your wishes. Sometimes, out of concern for your feelings, your family or loved ones might be reluctant to raise the issue of hospice for you.

Tips For Managing Dementia End

Because individuals with advanced dementia will often have difficulty communicating, it is important that caregivers keep a close eye on their loved one for signs of pain or discomfort. These signs may include moaning or yelling, restlessness or an inability to sleep, grimacing, or sweating. This may also signal that its time to call hospice or a palliative care team to help with the pain management.

If an individual with end-stage dementia is having trouble sitting up without assistance, hospice can provide a hospital bed or other equipment to lift their head.

Perhaps the hardest thing for families is when a loved one with dementia is no longer able to eat or swallow. Because an individual with dementia is unable to understand the benefits of feeding tubes or IV drips, they will often be incredibly distressed and attempt to remove them, causing added pain and risk of infection. Instead, focusing on keeping the individual comfortable. Supporting them with mouth care to prevent their mouth from becoming dry will allow them to make their final transition in peace.

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Choosing Hospice Care For End

Many families wonder when to put a dementia patient into hospice or palliative care. Patients with dementia may be unable to express their level of pain or may experience confusion about where they are and whats happening, which can leave family members responsible for making major health decisions for the patient.

While hospice care is typically considered end-of-life care, determining the illness stage can be complicated when it comes to patients with dementia. Its hard to decide on the life expectancy of a dementia patient. The memory journey is unique to each individual. Many insurance providers and Medicare use the Reisberg Functional Assessment Staging scale to determine eligibility for hospice care for someone with dementia. An older adult with a FAST scale ranking of 7 indicates severe dementia, along with a co-occurring condition, such as extreme weight loss, pressure ulcers, COPD, or pneumonia, is typically considered eligible for hospice care. Some symptoms exhibited by someone with severe dementia that warrants a FAST ranking of 7 includes:

• Inability to walk without assistance

• Inability to use the restroom without assistance

• Inability to complete daily tasks, such as eating and getting dressed, without help

• Incontinence of the bowel or bladder

• Inability to speak clearly or express thoughts and opinions

Support For People With Dementia And Carers

UCL covid-19 decision aid – a tool to support carers of people living with dementia to make difficult decisions during covid-19

Alzheimers Society end of life care information for patients and families

Alzheimers Society information and fact sheets on all aspects of dementia including what is dementia, types of dementia and living well with dementia

Alzheimer Scotland specialist services for patients and carers

Dementia UK expert one-on-one advice and support to families living with dementia via Admiral Nurses

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Place Of Care In The Last Phase Of Life

In developing palliative care for people with advanced dementia, it is important to consider circumstances of care such as place of care or where the person dies. The majority of people with early stage dementia live at home with family members caring for them. Approximately one third of people with dementia are cared for in nursing homes . A survey identified dementia in 68% of nursing home residents with only slightly more than half having recorded diagnosis and with more than half suffering from advanced dementia . People in the advanced stages of dementia spend most of their time in nursing homes . The likelihood of nursing home admission increases with age and severity of behavioural symptoms high burden of family carers is also associated with nursing home admission . People with migration background are less often cared for in nursing homes .

Barriers For Good Palliative Care For People With Dementia

Despite increasing knowledge of optimal care and the recommendation for early integration of palliative care in the course of disease, accompanied by disease modifying treatment , a number of reasons for barriers of good palliative care for people with dementia were identified .

Diagnosing dementia in the early phases can be challenging and lengthy, leading to delays early access to palliative care . Dementia is often not acknowledged as terminal and life limiting disease and consequently end of life is not taken into consideration or adequately addressed . Another barrier is the difficulty in predicting the duration of the disease or its anticipated course in contrast to cancer. Although experts have determined the average length of the different stages and length of the disease, accurate individual predictions remain challenging. Notably, people with dementia have limited access to hospice and palliative care .

Regardless of all efforts there is still no consensus on palliative care in dementia . The applicability and appropriateness of palliative care for people with dementia was also one of the controversies in the development of the EAPC White Paper on optimal palliative care for dementia . There is a great need for robust study results on complex interventions at the end of life . The optimal timing to integrate palliative care or adapt care goals or simultaneous goals to modify disease and to provide comfort is still in discussion .

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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.

Is My Loved One Safe At Home

There are several factors that you should consider when you evaluate the Alzheimers patients safety in their own home:

• Alzheimers disease can cause sufferers to put themselves at risk. They may, for instance, leave pans on the stovetop, leave the gas on, ingest poisonous chemicals, or slip and fall. They may wander out into the street and get lost, or stumble into traffic. There are steps that can be taken to make the home safer, but at some point, you may feel that your loved one would be more secure in a nursing home.
• If you are not physically strong enough to help them, then as they become more physically dependent on you, you may not be able to protect them from falls or safely lift them up.
• Some Alzheimers sufferers develop aggressive behaviors that could put others around them at risk. Or, if they are sharing the home with family members, their forgetful behavior could cause harm to their co-habitants.

Alzheimers facilities provide round-the-clock supervision, as well as full security if your family member has a tendency to wander.

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When An Alzheimers Patient Needs Hospice Care

The early stages of Alzheimers usually begin with difficulty recalling past events and eventually progress to speech impairment, recalling familiar names and faces, difficulty walking, and aggressive behaviors. The final stages involve the inability to swallow and loss of appetite, long hours of sleep, and being curled up in bed.

An Alzheimers Patient Is Ready For Hospice When:

• A doctor has diagnosed a life expectancy of 6 months or less. This criterion is universal for all hospice patients, regardless of their health conditions, as this care is designed to manage pain and focus on comfort in the last stages of life not provide treatment for a disease.
• They become totally dependent. In the final stages of Alzheimers, patients become totally dependent on caregivers for assistance in daily life and activities. This includes physical dependency, as many people are unable to walk, sit or attend to their personal hygiene.
• Weight loss increases. Late-stage Alzheimers patients struggle to take in enough food and liquid, have difficulty manipulating utensils, and even difficulty chewing and swallowing, which leads to weight loss.
• They are unable to communicate effectively. The loss of intelligent speech, inability to express themselves, and inability to respond to others indicate the disease is reaching its final phase.
• They are more vulnerable to other diseases and infections. Dealing with other health conditions along with Alzheimers can be exceptionally challenging, as many patients suffer from pneumonia and other infections.

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What You Can Do For Your Loved One

As an individual with dementia declines, you can help them by providing a loving and supportive presence. Sit with them. Hold their hand. Play music they enjoy.

One of the greatest gifts you can give your loved one is helping to get their affairs in order. Ensure that financial and healthcare powers of attorney are put in place, so you can make decisions when your loved one is no longer able. Look into funeral arrangements before you need them, so you dont need to make important decisions in a time of crisis.

Talk to your loved ones physician about the possibility of palliative care support in the home and hospice care when your loved one is ready.

When Is Your Dementia Patient Ready For Hospice Care

Alzheimer’s disease and other progressive dementias are life-altering and eventually fatal conditions for which curative therapy is not available. Patients with dementia or Alzheimers are eligible for hospice care when they show all of the following characteristics:1

• Unable to ambulate without assistance
• Unable to dress without assistance
• Unable to bathe properly
• Incontinence of bowel and bladder
• Unable to speak or communicate meaningfully

Thinking of dementia as a terminal illness from which patients will decline over a matter of years, rather than months, allows healthcare professionals to focus explicitly and aggressively on a palliative care plan.2

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Planning For End Of Life Care

When a person with dementia is approaching the end of their life, it can be a very difficult time for them and the people around them. However there are things you can do to support the person and other close family or friends.

Around this time you will probably be dealing with a range of different health and social care professionals. It will really help if there is good communication between all of the people involved in providing the persons end of life care.

Hospice Care For Alzheimers Patients

Hospice care is the form of care given to patients with a life expectancy of fewer than six months. Alzheimers disease progress at varying rates depending on each individual, so it could be difficult to determine their life expectancy. However, during the late stages of the disease, its important for the family to initiate the discussion on the option of hospice care with their doctor.

Alzheimers patients usually require more skilled and experienced Hospice specialists than an average hospice ward. Theyre to discuss with the families what to expect during the end stages of the disease and provide support throughout the whole process. Some of the symptoms that Alzheimers may present with that will suggest hospice care include serious forms of infection or multiple episodes of pneumonia, severe weight loss of greater than 10% in the space of 6months, and multiple pressure ulcers that are difficult to heal.

Loved ones of a patient with end stages of dementia with a life expectancy of greater than six months may also take advantage of palliative care, even before the patient qualifies for hospice services. Palliative care works hand in hand with treatment as provided by a healthcare specialist, so other co-morbidities are treated alongside Alzheimers disease.

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