Guías Médicas por Condición

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 Alzheimer’s are eligible for hospice care when they show all of the following characteristics:

• 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 (ability to speak is limited to approximately 6 or fewer intelligible and different words) 

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.

Intercurrent illnesses associated with advanced dementia include: 

• Aspiration pneumonia 

• Pyelonephritis or upper urinary tract infection 

• Septicemia 

• Decubitus ulcers, multiple, stage 3-4 

• Fever recurrent after antibiotics 

Impaired nutritional status: 

• Difficulty swallowing or refusal to eat 

• If receiving artificial nutritional support (NG or G-tube, TPN), patient must be exhibiting continued weight loss despite the feedings 

• Protein calorie malnutrition: 

  • Weight loss over 11% or 

  • BMI<18 or

  • Albumin <3.1 

Co-morbid conditions that significantly impair the dementia patient's health and functionality: 

• Congestive heart disease or cardiovascular disease 

• COPD or restrictive lung disease 

• Cerebrovascular disease, including stroke 

• Diabetes mellitus 

• Renal insufficiency 

• Malignancy

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CMS Medicare provides these guidelines as a convenient tool. They do not take the place of a physician's professional judgment.

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