Hospice Admissions Guidelines for Dementia & Alzheimer's
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
- 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
VITAS provides these guidelines as a convenient tool. They do not take the place of a physician's professional judgment.
- Diagnosis, Management and Treatment of Dementia. American Medical Association, 1999.
- 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.