Hospice for dementia: when is it time, and how long can they stay?
The short answer
People with dementia often qualify for hospice in the late stage, when they need help with nearly everything, speak only a few words, and have problems like weight loss, serious infections, or trouble eating. The hospice doctor makes the decision. Because dementia can move slowly, stays can be long, and people can stay on hospice as long as a hospice doctor recertifies that they qualify.
This topic involves medical decisions. It's general information, not advice for your person. Please talk with your hospice nurse or doctor before changing any medicine or care plan.
Signs it may be time to ask
Dementia changes slowly, so it's hard to know when to ask. It may be time to raise hospice with the doctor if your person:
- Can no longer walk, dress, or bathe without help
- Has lost control of bladder and bowels
- Speaks only a few words, or none that make sense
- Is eating and drinking less and losing weight
- Has had serious problems like pneumonia from food or liquid going into the lungs, repeated infections, or deep pressure sores
Asking is not giving up. The answer can be "not yet."
How is eligibility decided?
For Medicare to cover hospice, the hospice doctor, and your person's regular doctor if they have one, must certify that your loved one is expected to live 6 months or less if the illness runs its usual course.
With dementia, that is hard to predict. Doctors look at the whole picture: how much help your person needs, how well they communicate, weight loss, and recent infections. Medicare guidelines describe these late-stage signs, including a dementia staging scale. The hospice doctor makes the call.
What does hospice add?
Hospice focuses on comfort. Depending on the plan of care, it can include nursing visits, aide help with bathing, equipment, medicines for symptoms, social work, and spiritual care. Caregivers can also get short respite stays of up to 5 days.
People with advanced dementia often can't say what hurts. The National Institute on Aging notes that families of people with dementia who had hospice report better quality of care and more of their needs met at the end of life.
How long can someone stay?
Medicare covers two 90-day benefit periods, then an unlimited number of 60-day periods. At the start of each new period, a hospice doctor must recertify that your person still qualifies. Before the third period, that includes a face-to-face visit.
If your loved one's condition steadies or improves, they may be discharged. That can be hard to hear. If they qualify again later, they can go back to hospice. Read more about staying on hospice longer than six months.
Hospice in a nursing home
Hospice care can usually be given wherever your person lives, including a nursing home. The hospice team works alongside the facility staff.
Hospice doesn't cover room and board, so that part of the nursing home bill continues. Ask the facility's business office how hospice will affect what you pay.
Sources
- Medicare.gov, Hospice care: medicare.gov/coverage/hospice-care
- Medicare.gov, Medicare Hospice Benefits booklet: medicare.gov/publications/02154-medicare-hospice-benefits.pdf
- CMS Medicare Coverage Database, LCD L34538 Hospice Determining Terminal Status: cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=34538
- National Institute on Aging, Frequently Asked Questions About Hospice Care: nia.nih.gov/health/hospice-and-palliative-care/frequently-asked-questions-about-hospice-care
Educational information only. This article is not medical, legal, or financial advice, and it can't account for your person's health or your state's rules. Always talk with your hospice team, doctor, or Medicare (1-800-MEDICARE) about your situation. If you think it's an emergency, call your hospice's 24-hour number or 911.