The hospice guidelines, including a expected survival time of less than 6 months, were developed for the cancer model, where the course of the disease is more predictable. In dementia, the cause of death, is usually an infection, so it is difficult to predict when the life threatening infection will occur, so making a 6 month prognosis is not reliable.
The National Hospice Organization developed admission guidelines for non-cancer diseases. Essentially, for dementia, the patient must be at stage 7c.
What the guidelines mean is basically the LO needs to be completely in stage 7 (not able to walk independently and speech limited to one word) and with some form of complication. The complication needs to be something like bedsores, fever, difficulty in swallowing and choking, strokes, pneumonia and so forth. Once accepted though, they will be re-evaluated in three months. If the LO has not shown continuing decline or an has made an improvement they can be dropped from the program but accepted back later once an obvious decline is evident.
Hospice Admission Guidelines for Dementia --- Patient shows ALL of the following: (Patient is at or beyond stage 7C of the Functional Assessment Staging Scale {point 1 and 2 below}.) 1. Unable to ambulate without the assistance of another person. 2. Speech is limited to approximately six or fewer intelligible words (some hospices use the next requirement) 3. Unable to communicate meaningfully - speech is limited to a single understandable word on an average day - (or during the evaluation) (The single word may be repeated.) There is some variation on this point. Some hospices use 6 words as a limit. Some use a requirement similar to this -- No consistent meaningful/reality based verbal communication; stereotypical phrases or the ability to speak is limited to a few intelligible words. 4. Unable to dress or bathe without assistance 5. Urinary and fecal incontinence – (intermittent or constant)
AND - Patient has had one of the following within the past year: (Demonstrates a declining condition and likely future medical urgencies.) • Aspiration pneumonia • Upper urinary tract infection (kidney involvement) • Septicemia (blood infection) • Recurrent fevers after treatment with antibiotics • Multiple decubitus ulcers (bed sores) of stage 3 or 4 • Poor nutrition demonstrated by 10% weight loss in six months or low blood levels of nutrients ( Serum Albumin less than 2.5 gm/dl) or difficulty swallowing food or food refusal • Other significant medical event or condition that supports a limited prognosis (This additional point has been added by some hospices.)
Hospice is completely covered by Medicare. I believe there is a low co-pay for Hospice meds, but many hospices waive the co-pay. Meds for conditions not related to the terminal illness are not covered under the hospice benefit.
Hospice services are commonly provided in the home as well as in the Nursing home. When provided in the nursing home, the NH must have an agreement with the particular Hospice service. Some NH's do not have agreements with any hospice services.)
The patient agrees to stop "curative treatment" for their admitting condition. They will receive all necessary treatments for comfort. They may still receive conventional Medicare paid treatment for other medical conditions.
----------------------- Several members of this board have posted that their family members were qualified for hospice services, even though they did not yet seem to meet all the above requirements.
------------------ People with Alzheimer’s can also be admitted based on a more general "failure to thrive" classification, based on weight loss. There are also other specific criteria that may apply to allow admission for other conditions, such as heart, pulmonary, liver, or renal disease; or Stroke and coma.
Medicare brochure on Hospice "Medicare Hospice Benefits" http://www.medicare.gov/Publications/Pubs/pdf/02154.pdf
I found a hospice booklet on line that is pretty good- PDF booklet, 42 pages It discusses care practices, symptoms to expect at the end, etc. Franciscan Hospice and Palliative Care Hospice patient and family Information booklet https://www.fhshealth.org/services/HospiceBooklet.pdf
---------------------------- Admission criteria for other conditions.
There are now admission criteria for a number of non-cancer conditions.
Amyotrophic Lateral Sclerosis/ALS Cancer Cerebral Vascular Accident (CVA)/Stroke/Coma Dementia/Alzheimer’s Failure to Thrive/Adult Heart Failure/CHF HIV/AIDS Huntington’s Disease Liver Disease Lung Disease/COPD *Multiple Sclerosis/Neuro *Muscular Dystrophy/Neuro *Myasthenia Gravis/Neuro Non-specific Terminal Illness *Parkinson’s Disease/Neuro Renal Failure Acute Renal Failure Chronic
With minor variations, these criteria are followed by the Medicare Intermediaries (like Palmetto) in all the national regions. (Intermediaries are the Insurance companies that administer the Medicare payment program in the various regions of the country, and police the service providers.)
This list and description of the individual criteria from ----- http://www.advantagehch.com/docs/Hospice_Admission_Criteria_Book.pdf
Butterflygirl63 comments, "I am a bereavement coordinator/counselor for a Hospice, and this is correct. I have many alzheimer's patients. Occasionally, they will give a different diagnosis such as debility if the alz has not progressed far enough for medicaid/medicare criteria."
HOSPICE DIFFERENCES
All hospices programs, paid for by medicare, operate under the same rules and requirements about what they must provide. But there can be differences. Some may be reluctant to handle dementia patients. Some may not send the aides out as often, especially in the earlier times. Frequency of visits are not mandated so this can be quite variable.
In any major area, there is likely to be one or two non-profit hospices, and several for-profit hospices. The for-profits are usually associated with one of the large national corporations, or associated with a home healthcare company.
The non-profits will likely have their own facility, for inpatient respite care and times when critical care is needed. The for profits will likely contract inpatient care from a nursing home.
It is reasonable to believe that a non-profit is going to be more generous with it's service frequency, but you need to ask specificly during the selection process.
from an on-line blog discussion --- "After working for both for-profit and non-profit. . . In my 14 years of working in the hospice field I can honestly state that ownership has always played a role in whether or not the patients and their families truly received the highest quality of services.
While it is true that all Medicare certified hospices provide the same core services, how the hospice goes about providing the service and to what extent the hospice and its staff go beyond the call of duty can be the difference between night and day. Staffing levels, visit frequency, supplies offered, and extra support services often vary based on what the real priority of the hospice is (profit)."
[This Message was Edited on 04/11/2008]
