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Hospice Admission Guidelines

Alzheimer's Disease

LCD Guidelines

Dementia Due to Alzheimer's Disease & Related Disorders

Patients will be considered to be in the terminal stage of dementia (life expectancy of 6 months or less) if they show all of the following characteristics:

1. Stage 7 or beyond according to the Functional Assessment Staging Scale
2. Unable to ambulate without assistance
3. Unable to dress without assistance
4. Unable to bathe without assistance
5. Urinary & fecal incontinence, intermittent or constant
6. No consistently meaningful verbal communication: stereotypical phrases only or the ability to speak is limited to six or fewer intelligible words

Patients should have one of the following within the past 12 months:

1. Aspiration pneumonia
2. Pyelonephritis or other upper urinary tract infection
3. Septicemia
4. Multiple decubitus ulcers, stage 3-4
5. Recurrent fever after antibiotics
6. Inability to maintain sufficient fluid & calorie intake with 10% weight loss during the previous 6 months or serum albumin <2.5 gm/dl

MRI Scan Image_edited.jpg

Comparative Data

Fast Score - Document on continually, on admit Fast 7a now 7c
PPS/ADL - PPS score change, 1 month ago PPS 50% now PPS 30%, Patient was 2 person transfer, now requires Hoyer lift
Intake change - Was eating 100% of meals now only eats 50% of meals, Patient is pocketing food, Diet change from regular to pureed, Patient was eating independently but now requires assistance
Weight Change - Lost 10lbs in last month, lost 10% of body weight in last 6 months
Alert/ Oriented - On admission patient was sleeping 10 hours a day, now sleeping 15+ hours a day
Skin Issues - Should be documented on every visit, redness noted to coccyx, previously had no skin issues
Activity - Patient can no longer move themself in wheelchair, could move independently in wheelchair on admission, patient is leaning in wheelchair and now requires lateral support
Infections - New and/or recurrent infection(s)
Fever - Recurrent fever


Kidney Failure
Skin Issues


Available 24/7

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