Hospice Admissions Guidelines for Dementia & Alzheimer's

Are you a patient, family member, or caregiver? Learn about how VITAS can help patients with end-stage 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 
• Septicemia 
• 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
• Malignancy

VITAS provides these guidelines as a convenient tool. They do not take the place of a physician's professional judgment.

Sources:

1. Diagnosis, Management and Treatment of Dementia. American Medical Association, 1999. 
2. 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.