When An Alzheimer’s Patient Begins Hospice Care

By Barbara Karnes

First, I’m going to switch from the word Alzheimer's to the word dementia. Alzheimer's is a specific disease associated with dementia. Dementia as defined by the Oxford Language Dictionary is a “condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking and often with personality change, resulting from organic disease of the brain.”

The CDC states that dementia is “not a specific disease but is rather a general term for the impaired ability to remember, think or make decisions that interferes with doing everyday activities. Alzheimer’s disease is the most common type of dementia.”

With dementia defined, let's now talk about dementia and a hospice referral. Hospice provides care and services for people in the last six months of their life. A doctor must specify, in his/her best opinion, that this person has less than  six months of life. Every 90 days of that six month period the physician must recertify that reasoning.

If the person’s disease is continuing to progress toward a death within six months, the doctor can recertify a patient for an additional sixty days at the end of the original six months. There are all sorts of fancy words to outline this Medicare protocol but simply put, if the patient isn’t dying fast enough, at some point they have to come off of hospice services.

The basic areas that say a person has entered the dying process are: gradual decrease in eating, gradual increase in sleeping, and gradual withdrawal from social interactions. This generally occurs over a period of months when disease is involved and years with old age and no disease present.

This is how most people progress toward death BUT not with dementia. A person with dementia can be withdrawn and non communicative for years. A person with dementia can sleep all the time for years. It isn’t until a person can’t eat enough calories for maintenance (choking, holding food in their mouth, not swallowing) that we in the medical arena can say a person has entered the dying process. If we don’t eat we can’t live. Now the person is ready for hospice care…

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