When someone has dementia, it can be challenging to determine when hospice care is appropriate. Hospice is a palliative care organization. It provides end of life services, like comfort care and support, for people with life-limiting illnesses, such as dementia. Therefore, it’s only natural to want your loved one to have the best care when they’re struggling to live with this condition. But when does hospice care start?
What are the hospice eligibility criteria? Alzheimer’s and dementia patients are considered eligible for hospice care when they cannot ambulate, dress, and bathe without assistance. Other eligibility criteria include inconsistent bladder and bowel movements and the inability to communicate meaningfully.
The hospice care criteria for dementia and Alzheimer’s patients is a set of guidelines that can help family caregivers know when it’s time to consider hospice services. However, it’s not always easy to tell.
We’ll explore the topic in detail to help you make an informed decision and get your loved one the help they need and deserve,
What Does Hospice Mean For Dementia Patients?
Dementia is not actually a specific disease. Instead, it a broad term for a group of related disorders that cause a cognitive decline or impairment in brain function.
Alzheimer’s disease is the most common form of dementia. As many as half of all people age 85 or older may have dementia, according to Alzheimer’s.gov.
Seeing someone you love wage a losing battle with dementia is never easy. Not only does it take its toll on your well-being, but you may feel guilty for not being able to help them more.
The good news is that there are ways to ease the burden until their final days. Meaningful hospice care services can be powerful tools in helping end-stage dementia patients live better lives.
Hospice serves patients in the end stages of a terminal illness, offering them peace of mind and comfort care.
The service’s goals of care are not to prolong life but, rather, to make the patient’s final days less painful and more manageable. It also eases anxiety and worries for the loved ones of the patient.
Hospice care is usually provided at home, though some patients who live in a facility can benefit from hospice services. In this setting, you’ll find trained professionals ready to help your loved one cope with their condition through physical therapy, emotional support, or pain management techniques.
It’s also not uncommon for home hospice care patients to be transferred to a hospice inpatient facility when their condition becomes too overwhelming to handle at home.
What Are The Overall Benefits Of Hospice Care?
Deciding to put your loved one into hospice care is never an easy decision, but it’s important to remember that hospice is not a place where people go to die.
In fact, the overall goal of a hospice care plan is to improve the quality of life for patients and their families by providing them with comprehensive support.
Some of the benefits of hospice care include:
- Pain relief: The facilities are equipped with state-of-the-art pain management techniques to help patients in the final stages of their illness.
- Patient comfort: Hospice nurses are experts in providing palliative care, and they will work to make your loved one as comfortable as possible.
- Emotional support: Families of hospice patients often find it helpful to have someone who understands what they’re going through. A hospice social worker is typically available to provide emotional support 24/7.
- Continuous care: Patients receive ongoing care from their hospice team, which means they don’t have to be transported back and forth or wait for an available bed.
And as we mentioned, hospice care can be provided at home, which people often prefer. This allows family members and loved ones to spend one last precious time with their loved ones before they pass away.
What Are The Criteria That Must Be Met For A Person To Receive Hospice Care?
Dementia and Alzheimer’s disease are already challenging conditions to manage. When a person is diagnosed with advanced dementia, their quality of life will likely severely diminish.
In these cases, families must have open communication with the patient’s doctor so that they can determine if hospice care is an option worth exploring.
In general, people who require hospice services must meet all of the following criteria for eligibility:
- Unable to ambulate without assistance.
- Difficulty dressing without help.
- Inconsistent bowel and bladder movements.
- Unable to bathe properly on their own.
- Inability to speak or communicate meaningfully. The ability to speak is limited to half a dozen or less intelligible and different words.
Can Dementia Be Primary Diagnosis For Hospice?
Hospice care primarily deals with end-of-life care, so dementia can only be the primary diagnosis if it’s determined that the patient has less than six months to live.
If the patient is deemed ineligible for hospice care based on their life expectancy, their dementia will be treated as a secondary diagnosis.
Secondary diagnosis refers to any other illness or condition that is not the main reason for hospice care.
For example, in the case of dementia, this would be any other health problem that is causing complications or exacerbating the symptoms of dementia.
Some common secondary diagnoses that can accompany dementia include:
- Urinary tract infection
- Decubitus ulcers, multiple, stage 3-4
- Aspiration pneumonia
- Fever recurrent after antibiotics
When Do Dementia Patients Go Into Hospice?
Patients with dementia are considered eligible for hospice admission if they’re believed to have 6 months or less to live.
However, life expectancy is only determined by a doctor’s clinical judgement. It’s essential to keep in mind that this number can change drastically depending on the patient’s condition.
There are a few things that can influence when a dementia patient enters hospice:
- The stage of the disease
- How well the patient is responding to treatment
- Their overall health status
- How fast the illness is advancing
Dementia progresses slowly, and it is difficult to determine when the disease has progressed enough that your loved one should go into hospice care.
If you’re not sure that it’s time, the following situations are good indicators of severe dementia:
- The patient is bed-bound.
- The patient can only say a few words.
- The patient is entirely dependent on their loved ones for grooming, dressing, and other essential tasks.
- The patient is showing signs of severe anxiety.
If you’re still in doubt, it’s advisable to seek professional help to make the decision. Hospice nurses can perform a thorough evaluation and advise you on whether hospice care is appropriate.
In addition, not all hospices are the same. There are certain questions you should ask to help you select the right hospice for your loved one’s unique set of needs.
For instance, you’ll want to know if the hospice has employees, not just volunteers. Are the team members certified? Are support services available to your senior (and you) 24/7, and on weekends and holidays?
How Long Do Dementia Patients Live On Hospice?
As we’ve mentioned previously, a hospice provider usually won’t accept a dementia patient (or anyone who has a poor prognosis) unless their estimated life expectancy is less than six months.
That said, the timeline for the terminal stage of dementia varies from person to person.
For example: if the person has any additional medical conditions, these illnesses may hasten their passing.
Certain secondary conditions such as congestive heart failure, renal disease or chronic renal failure or a metastatic disease may cause their health to worsen quickly.
Crossroads Hospice reports the following timeline for the final six months of dementia disease progression:
Final Six Months
- A diagnosis of another condition such as cancer, congestive heart failure or COPD
- An increase in hospital visits or admissions
Final Two-to-Three Months
- Speech limited to six words or less per day
- Difficulty in swallowing or choking on liquids or food
- Unable to walk or sit upright without assistance
- Hands, feet, arms and legs may be increasingly cold to the touch
- Inability to swallow
- Terminal agitation or restlessness
- An increasing amount of time asleep or drifting into unconsciousness
- Changes in breathing, including shallow breaths or periods without breathing for several seconds or up to a minute
During their final months, be sure to send time with the person. It will be a comfort to them, as well as for you.
If you haven’t already gotten a power of attorney for their medical care or to take care of their finances, now is the time to do so.
Also, this may be a good time to begin making funeral arrangements. I know from personal experience that grief can alter the way you make decisions.
Dealing with these difficult tasks can be slightly easier if you can take care of most of them before the person passes.
If your loved one has dementia, you can explore hospice care as a potential option. However, it’s crucial to note that before you move forward with this route, you should consult your physician and medical team about whether it is the right choice for your loved one at this time.