Hospice consultations for Alzheimer’s patients in the final stages of their illness will enhance their quality of death, relieve the strain of end-of-life care on families and nursing facility personnel, and reduce Medicare and Medicaid costs. When dementia has reached its latter stages, doctors and their extenders should think about involving hospice.
A progressive neurological condition known as Alzheimer’s disease, which affects an estimated 5.5 million people in the US. For both patients and their families, the sickness is intolerably difficult. We all know how difficult it may be to care for a parent or spouse who has this unsightly disease because we have patients who do so. Overwhelmed and depressed caregivers are common outcomes. When an Alzheimer’s patient enters the final stage of the illness, they frequently require feeding assistance, are bowel and bladder incontinent, and frequently forget the names of their family members. In a seated position, they won’t even be able to hold their head up. These patients need complete care, and for the devoted spouse, son, or daughter, it is not an easy journey.
The Hardships of Caretaking
Both the financial and emotional expenses are excruciating. The Alzheimer’s Association estimates that in the United States, the cost of caring for people with Alzheimer’s (and other dementias) will come to about $250 billion. The costs associated with dementia in the last five years of life total more than $287,000, which is more than the anticipated cost of rearing a kid from birth to the age of 18; this is particularly telling. Medicare and Medicaid are responsible for the majority of these expenses. Approximately $175 billion of Medicare and Medicaid combined budgets will be used to care for people with Alzheimer’s and other dementias.
Hospice is a Medicare-covered benefit that enables people to pass away in peace. Additionally, it offers volunteer services, grief support, and other family/caregiver assistance. Every person with end-stage Alzheimer’s disease deserves a hospice consultation. Therefore, when should you, as the main caregiver, request a hospice consultation? The criteria for hospice care in end-stage Alzheimer’s disease are broken down as follows.
Important Criteria for Hospice Care for Alzheimer’s Patients
The patient must have a Reisberg’s Functional Assessment Staging (FAST) scale score of 7C or higher for dementia severity. The FAST score can be used to determine how far along Alzheimer’s is. The patient must satisfy the following requirements in order to have a FAST score of 7C:
- Cannot walk without support
- Cannot dress alone
- Can’t bathe independently
- Blood and urinary incontinence
- Cannot say more than six words intelligibly per day or cannot communicate meaningfully through speech
The patient should also have had one of the comorbid conditions listed below within the last six months:
- Pneumonia with Aspiration
- A number of successive stage 3–4 decubiti
- Fever following antibiotics
- Weight loss of 10% of body weight in 6 months or albumin levels of less than 2.5 gm/dl indicate an inability to maintain hydration and calorie intake necessary for survival
The general alterations listed below that show a deterioration will support the end-stage diagnosis:
- Disease (UTI, URI, cellulitis)
- Uncontrolled discomfort or other signs
- Psychosocial problems
- Postural hypotension, edema, ascites, pleural/pericardial effusion, and hypotension with a systemic BP less than 90
When the aforementioned conditions are met, the clinician should consult hospice after evaluating the patient. Aides who will assist with bathing, nurses who may help with prescriptions and comfort, volunteers who can bring a pet or a musical instrument, chaplains who can offer spiritual support, and bereavement counselors who can assist the family in dealing with the loss are all provided by hospice.
Finding the Right Hospice Care
In the case of end-stage Alzheimer’s, the hospice staff can be vital in assisting the families in making the decision to designate the patient as a do-not-hospitalize or do-not-resuscitate patient. Instead than trying to extend a life whose quality is terribly lacking, the focus should be on comfort. In addition to being very costly for the insurance provider, multiple hospital stays for the treatment of dehydration, aspiration pneumonia, and urinary tract infections are also devastating for the end-stage Alzheimer’s patient, who may go into a coma and would likely feel much more at ease in his or her familiar bed at home. The patient and the family are both grateful for the hospice present. Additionally, it is a gift to Medicare and Medicaid as the patient won’t have to visit the hospital more frequently, reducing expenses and utilization. Please think about giving the gift of hospice.