Can hospice step in if an Alzheimer's patient no longer wants to be hospitalized?

A fellow caregiver asked...

When the patient has many health issues besides Alzheimer's, but does not wish to be hospitalized any more can hospice step in even though there could be more than 6 months remaining?

Expert Answer

Audrey Wuerl, RN, BSN, PHN, is education coordinator for Hospice of San Joaquin in California. She is also a geriatric trainer for the End-of-Life Nursing Education Consortium (ELNEC), which promotes education in geriatric nursing and end-of-life care.

The Hospice Benefit requires that patients have a prognosis, or life expectancy, of 6 months or less as determined by their doctor. This is really an end-of-life benefit when cure is no longer an option and all therapies have been completed. Most patients with Alzheimer's disease will have other conditions that can shorten their life or actually be the cause of their death. We call these, co-morbities.

When we work with physicians whose patients have Alzheimer's, we use the Functional Assessment Scale to determine which stage the patient is at. At stage 7, there is a marked decrease in psychomotor skills such as walking, or even sitting up. Most will be bedbound. Difficulty with eating and swallowing safely can also be lost. This is why there may be a gradual (but continuous) weight loss. Language skills and the ability to communicate are often absent at this stage. Generally, the patient will have been institutionalized in a nursing home because the family cannot care for him/her in the home setting.

Sometimes, the Alzheimer's patient who is placed on hospice services lives longer then 6 months. The patient can remain on the hospice benefit as long as there is a continuous decline and the physician certifies that the prognosis is still 6 months or less (even though now it is longer). Keeping people in their own home, which could be a nursing home, is the intent of this type of care. I would encourage anyone to speak to their loved one's physician and learn if hospice services would be appropriate.