Today I’m reviewing the CMS Disease Specific Guidelines for For Prognosis Of Dementia due to Alzheimer’s Disease and Related Disorders for Hospice Admission Criteria.
If the CMS Disease Specific Guidelines criteria are met for Alzheimer’s And Related Disorders, then the patient is considered to have a six month prognosis and hence is eligible for hospice care.
However, Resource (3) below, Advanced Dementia, from the New England Journal of Medicine warns us that:
Estimating life expectancy in cases of advanced dementia is difficult.11,12 Eligibility guidelines for the Medicare hospice benefit require that patients with dementia have an expected survival of less than 6 months, as assessed by their reaching stage 7c on the Functional Assessment Staging tool (a scale ranging from stage 1 to stage 7f, with stage 7f indicating the most severe dementia) [See Resource (2) below] and having had one of six specified complications in the past year (Table 1).13 However, these eligibility guidelines do not accurately predict survival.11,12 An alternative measure — a risk score to predict 6-month survival among patients with advanced dementia — was derived with the use of nationwide Minimum Data Set information (a patient assessment instrument federally mandated in U.S. nursing homes) and then prospectively evaluated in 602 nursing home residents.11 The predictive ability of the score for 6-month survival was moderate (area under the receiver-operatingcharacteristic curve [AUC], 0.68) but better than that of hospice eligibility guidelines (AUC, 0.55). Given the challenge of predicting life expectancy among patients with advanced
dementia, access to palliative care should be determined on the basis of a desire for comfort care, rather than the prognostic estimates.
With the above caveats in mind, what follows are The Hospice Elibility Criteria for Alheimer’s Disease and Related Disorders.
All that follows is from Resource (1) below:
CMS Disease Specific Guidelines (LCDs)
A patient is eligible for hospice services if he
meets these three criteria:
1) has a Palliative Performance Scale [link is to my post on the scale] of less than 70%
2) is dependent on at least two Activities of Daily Living Resource below , and
3) meets the Disease Specific GuidelinesAlzheimer’s And Related Disorders
Patients will be considered to be in the terminal stage of
dementia (life expectancy of six months or less) if they
meet the following criteria.
1. Patients with dementia should show all the following
characteristics:
a. Stage seven or beyond according to the Functional
Assessment Staging Scale;
b. Unable to ambulate without assistance;
c. Unable to dress without assistance;
d. Unable to bathe without assistance;
e. Urinary and fecal incontinence, intermittent or
constant;
f. No consistently meaningful verbal communication:
stereotypical phrases only or the ability to speak is
limited to six or fewer intelligible words.2. Patients should have had one of the following within the
past 12 months:
a. Aspiration pneumonia;
b. Pyelonephritis;
c. Septicemia;
d. Decubitus ulcers, multiple, stage 3-4;
e. Fever, recurrent after antibiotics;
f. Inability to maintain sufficient fluid and calorie intake
with 10% weight loss during the previous six months or
serum albumin <2.5 gm/dl.Note: This section is specific for Alzheimer’s disease and
Related Disorders, and is not appropriate for other types
of dementia.
Resources:
1. Determining Hospice Eligibility In Terminally Ill Patients Hospice by The Bay – An Affiliate Of USCF Health, Updated 3-2014
2. Seven Stages of Dementia | Symptoms & Progression – Global Deterioration Scale for Assessment of Primary Degenerative Dementia (GDS), The Functional Assessment Staging (FAST) Test, and Clinical Dementia Rating (CDR) Scale from Dementia Care Central
3. Advanced Dementia [PubMed Citation] [Full Text HTML] [Full Text PDF]. N Engl J Med. 2015 June 25; 372(26): 2533–2540. doi:10.1056/NEJMcp1412652.
