Dementia Care in Hospice

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Dementia Care in Hospice

Understanding the role hospice care plays for advanced dementia patients is vital to providing the best quality of life. Understand how hospice care can help and the Hospice criteria for dementia. Below is a story of how Hospice care for Dementia made a difference in this families life, as well as hospice eligibility criteria for Alzheimer’s and dementia care in hospice.

Joseph was living in a nursing facility following a series of strokes. As his dementia advanced and his health deteriorated, his family chose to begin hospice care with Varco. Joseph was always cheerful, despite his ability to self-feed and speak slipping away. His day-to-day care became more rigorous, and his facility welcomed the added skilled hands of the Varco Hospice team.

As care for Joseph intensified, so did our interaction with his lovely wife. Ingrid met Joseph soon after WW2 when she came to this country from Austria and took a job as a secretary in Joseph’s company. She was living through many stages of grief as Joseph’s dementia progressed. Many of Ingrid’s memories were of Joseph as a powerful executive, and his changes both saddened and angered her. Due to dealing with her health problems, worrying about his care expenses, and actively grieving her losses, our physical care was for Joseph. However, our emotional and spiritual care was for Ingrid as well.

Dementia care plan management in Hospice

In Hospice, our dementia care management plans change throughout disease progression. When the patient has Moderate Dementia, his needs will differ from when he is at the End Stage. Here are just a few adjustments we’ll make as dementia progresses.

1. End certain medications: Aricept or Namenda are two that we often discuss discontinuing when patients advance to End Stage dementia. The side effects outweigh the benefits (which are nil at this stage).
2. Wound care: For patients who are bedbound, incontinent, have compromised nutritional status, and have low albumin, pre-albumin, and serum protein levels, there is little chance that wounds will heal. Our focus becomes on relieving any pain and preventing the further spread of the damage or infection.
3. Nutrition: In End Stage dementia, we will place many patients on a mechanical soft or pureed diet due to dysphagia and the risk of aspiration. The required caloric intake, too, will be less.

Conversations with family

Like many conversations with family members facing Hospice for a loved one, this one is not easy. Often with advanced dementia, family members have already begun grieving for the person they used to know. Hospice providers are additional hands and hearts to care for the patient. Many caregivers may not know Hospice’s role in supporting the family. Hospice professionals support families, whether it’s an hour’s respite while a volunteer visits, a skilled hand at ADLs, or a chance for a coffee and an uplifting conversation. 

Ingrid was surprised at the time we spent with her. At onboarding and throughout, hospice staff will reiterate information about hospice services. The care team will also provide hands-on training and tips for caring for the patient, direct the family to online resources or support groups, and educate them about disease progression. We will repeatedly share these skills in our tool belts with families, primarily because of the longer length of stay for those with dementia.

What’s necessary but not always available?

Hospice is about the patient’s wishes.

For most, signing on to Hospice is a decision. For patients with dementia, informed consent may not be possible at this stage. In this case, caregivers must follow state-specific laws about admission to hospice service.

Hospice is about family. 

Like many things in life, caring for patients on Hospice is about finding the unique individual in each and making a connection. When families are involved, we have a unique insight into the patient. The family knows the patient better than anyone and becomes the patient’s voice. However, the reality is that not every hospice patient has a family. 

Hospice still happens. For patients with dementia, finding that unique spark may be more complicated. Still, our challenge as healthcare and hospice professionals is to meet the patient where they are, provide comfort, relieve pain, and support the families walking beside them. What could be more meaningful?

Hospice Eligibility Criteria for Dementia care

Over 5 million Americans live with Alzheimer’s disease and related dementias. Over 15 million family caregivers provide unpaid support to their loved ones with Alzheimer’s or other dementia.

In the early stage of Alzheimer’s, individuals experience memory lapses such as misplacing objects or having trouble identifying the right word or name. They can still function independently but will have increasing problems with planning and organization.

As patients reach the moderate/middle stages, they will begin to require more care. This stage typically lasts longer than any others – often for several years. During this time, the individual begins to experience more severe memory loss and confusion. They may be unable to remember names and forget where they are.

In end-stage dementia, individuals require 24-hour care for daily living. Patients lose awareness of recent experiences and their surroundings. They have increased difficulty communicating—individuals with late-stage Alzheimer’s become vulnerable to infections, especially pneumonia. During end-stage dementia, caregivers must anticipate their loved one’s needs. They may even forget how properly use a straw or how to swallow.

Due to the slow progression in individuals with Alzheimer’s disease and other dementias, families are often unsure if their loved one is eligible for Hospice care. A patient must exhibit specific symptoms to qualify for hospice care. Please review the list of commonly seen symptoms to determine if your loved one is showing any of these symptoms and define the next steps.

Hospice eligibility criteria for dementia care : 

For dementia patients to meet the hospice eligibility criteria, they must have a prognosis of 6-months or less. For many patients, it may be time to consider Hospice when their physical condition declines. Some key things to look for include the following:

• A diagnosis of other conditions such as COPD, CHF, cancer, or congenital heart disease
• frequent visits to the doctor, An increase in hospitalizations, or trips to the ER
• A diagnosis of pneumonia or sepsis
• Weight loss and dehydration because of eating or drinking challenges
• Speech becomes severely limited
• Inability to swallow or choke on food or liquid
• Urinary and fecal incontinence
• require sitting in unique chairs due to inability to sit upright without armrests on chairs or may slip out of chairs
• Mobility assistance becomes necessary (walker, wheelchair, etc.)
• Cannot sit up without assistance
• Lose the ability to smile

Hospice dementia symptom management. 

Varco Hospice and Home Health create an individual interdisciplinary plan of care to meet each patient’s unique needs. Our team provides medical care for the symptoms of patients with Alzheimer’s or other dementia diseases. Including pain, anxiety, and personal care to assist caregivers in maintaining the patient’s dignity at end-of-life.

Medication-related to the patient’s primary diagnosis and medical supplies, such as incontinence products, hospital beds, and wheelchairs, are delivered to the patient eliminating the need to run to the pharmacy or research medical supply providers. The hospice benefit covers these and many other benefits for the patient or family at no charge.

Hospice support for advanced dementia and Alzheimer’s care

Various teams of emotional and spiritual support specialists provide support to family caregivers’ education, and volunteers spend time with patients so family members can take a break. Varco also assists families with end-of-life planning, funeral arrangements, and bereavement support.

Varco Home Health and Hospice can partner to provide an extra layer of one-on-one care and attention for the patient already receiving care in a memory care unit or other long-term facilities. This extra care layer includes complementary therapies and activities to supplement the patient’s clinical and personal care. 

Making the most of the patient’s lucid moments and ensuring the patient is comfortable and free of pain even when they can no longer communicate their needs. Varco’s goal is to provide an enhanced quality of life for patients with end-stage Alzheimer’s disease or other dementias.

Primary Care Physicians should know…

Varco home health and Hospice is your partner in providing support to patients with late-stage Alzheimer’s or dementia. We admit new patients 24 hours a day, seven days a week. Plus, our expert staff of pain and symptom management professionals will work with you, the patient, and their family members to make the transition to Hospice as easy as possible.

Does your patient not meet the hospice criteria for dementia? You may want to consider palliative care. Our palliative care team works with physicians to treat symptoms and side effects, alleviate pain, and address family questions and concerns. Our team reports regularly to the primary care physician. We are providing an extra set of well-trained eyes and ears in the patient’s home environment and alerting you to any changes in the patient’s condition.

When to call Hospice

Family members can find it challenging to determine when a patient becomes eligible for hospice care due to the progression of Alzheimer’s disease and other dementia. This time frame makes the conversation about Hospice exponentially more critical. This way, you have a plan in place should the hospice eligibility criteria for dementia be met.

Varco is always available to assess patients in their home environment. The home environment could be their home, a hospital, assisted living facility, etc., to determine whether they meet hospice care requirements for dementia. We are happy to meet families at the time and place most convenient for them.

To arrange a hospice consultation, don’t hesitate to get in touch with us at 713-581-9198. Our 5-star Care Team is available 24 hours daily to take your call.