Although the average life expectancy for a person with Alzheimer’s is four and a half years, some live over 10 years with it. To be eligible for hospice, the patient is expected to die within six months (if the disease runs its usual course), which frequently occurs if they meet the following two criteria:
(1) Be at a FAST Stage ‘7c’. Alzheimer’s progresses through seven stages: FAST means Functional Assessment STage; Stage 7 is the final one and indicates the patient is dependent on others for all their ADL’s (Activities of Daily Living – dressing, toileting, bathing, eating), can speak only a few words intelligibly and can no longer get from bed to the toilet without assistance.
(2) In addition, they must have had at least one of the following conditions in the past six months: heart failure, emphysema [COPD], over 10% weight loss, a Stage 3 or 4 pressure sore (muscle or bone exposed), a recurring kidney infection, fever despite antibiotics, a recurring aspiration pneumonia, be over age 70, or have a blood albumin less than 2.5.
It’s not easy to estimate when the last six months of life starts. For example, just after a hospitalization for pneumonia or a fractured hip, the doctor will feel hospice is appropriate. But then, after a few months in hospice, the patient appears stable—their care is ‘custodial’ rather than ‘terminal’, meaning they won’t likely die in the next six months.
When that happens, hospice must discharge them. However, they can be readmitted when further decline occurs.