Hospice Admissions Guidelines for Dementia & Alzheimer's

Download a PDF of these guidelines.

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: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 (ability to speak is limited to approximately a half dozen 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.2

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

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

Sources:

  1. Diagnosis, Management and Treatment of Dementia. American Medical Association, 1999. 
  2. Reisberg B: Dementia: A Systematic Approach to Identifying Reversible Causes. Geriatrics, 41:30, 1986.

Adapted from Stuart B, Herbst L, Kinzbrunner BM, et al: Medical Guidelines for Determining Prognosis in Selected Non-Cancer Diseases. 2nd edition. Virginia: National Hospice Organization, 1996. 

Learn if VITAS can help you care for your patient.

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