Hospice and Alzheimer’s Disease

We understand the challenges when choosing hospice or referring those with late-stage Alzheimer’s disease. Our care coordinators and medical directors are here to listen to your concerns and share their experiences with care and eligibility requirements.

Ultimately, hospice referrals should weigh experienced clinical judgement, Functional Assessment Staging (FAST), and input from family members about a patient’s prognosis. Physicians and executive directors at our local programs are available to answer your questions.

The FAST scale is helpful for evaluating patients at the moderate to severe stages of dementia when the Mini Mental State Examination (MMSE) can no longer reflect changes in a meaningful clinical way.

Generally, patients will be considered to be in the terminal stage of Alzheimer’s disease if they meet the following criteria:

Number 1 plus either 2 or 3 MUST be present:

1. Stage 7 on the Functional Assessment Staging (FAST) Scale (PDF, 1.1 MB) – A, B & C criteria are very important indicators of end stage Alzheimer’s disease.

Additional criteria supporting a terminal status:

  • Incontinence
  • Inability to communicate meaningfully (1 to 5 words a day)
  • Non-ambulatory (unable to ambulate and bear weight)
  • All intelligible vocabulary lost
  • Unable to sit up independently
  • Unable to smile
  • Unable to hold head up

2. Presence of co-morbid disease distinct from the terminal illness will impact functional impairment. The combined effects of Alzheimer’s and any co-morbid condition should support a prognosis of 6 months or less.

  • COPD
  • CHF
  • Cancer
  • Liver Disease
  • Renal Failure
  • Neurological Disease

3. Patients should have had one of the following secondary conditions within the past 12 months:

  • Delirium
  • Recurrent or intractable infections, such as pneumonia or other URI
  • Pyelonephritis or other urinary tract infection
  • Septicemia
  • Decubitus ulcers, multiple, stage 3-4
  • Fever, recurrent after antibiotics
  • Inability to maintain sufficient fluid and calorie intake demonstrated by either of the following: 10% weight loss during the previous six months OR Serum albumin < 2.5 gm/dl
  • Aspiration pneumonia

If a patient meets the medical criteria above, they are by definition eligible to receive hospice services. Some patients may not meet the criteria, but may still be eligible for hospice care due to comorbidities or rapid functional decline. 

Contact a care coordinator or medical director at a local Compassus program for specific eligibility information.