At What Point Will Hospice Provide Care for Someone With Alzheimer's?

A fellow caregiver asked...

At what point will hospice provide care for someone with Alzheimer's?

Expert Answer

Barbara Repa, a senior editor, is an attorney, a journalist specializing in aging issues, and the author of Your Rights in the Workplace (Nolo), now in its 10th edition.

Not all hospice providers use the same criteria for admission, but some standards are beginning to evolve. To be eligible for hospice care, the patient must generally be unable to:

  • Walk without assistance

  • Dress without help

  • Bathe or groom properly

  • Eat appropriately on his or her own

  • Control bowel or bladder

  • Speak or communicate meaningfully

In addition, the patient must be suffering from a severe related health issue, which may include:

  • Pneumonia

  • Signs of a recent stroke

  • Upper urinary tract infections

  • Open bedsores

  • Recurrent fever

  • Serious nutritional problems

But because hospice is typically reserved for people who have fewer than six months to live, Alzheimer's patients (who often have uncertain final time trajectories) or their caregivers have sometimes had to do some lobbying to get medical personnel to back their choice and hospice providers to provide the service.

However, new guidelines are helping by removing the onus from doctors who were uncomfortable making the prognosis that a person with Alzheimer's or related diseases has only six months or less to live.

The guidelines also give added weight and encouragement to Alzheimer's patients and their caregivers who find hospice care, with its goal of alleviating pain and discomfort, to be the most affordable care of choice. These guidelines were recently recognized by the government's Centers for Medicare and Medicaid Services -- an essential endorsement because Medicare pays for the lion's share of hospice services. Many hospice providers simply don't have the financial resources to care for those with Alzheimer's without Medicare coverage, and many patients can't afford it on their own. While many hospice providers claim they won't turn away anyone who can't afford to pay, strapped budgets sometimes make it impossible to keep this promise.

Finally, a patient with dementia often lives longer than the six-month limit some hospice providers establish. Should this happen, he or she can now be recertified for additional 30-day periods and continue receiving Medicare coverage.

For more information on Medicare coverage and hospice care, see the booklet published by the Centers for Medicare and Medicaid Services, Medicare Hospice Benefits.