Hospice Care for Alzheimer's Disease and Dementia

If you are reading this, it is likely you or someone you love has been waging a difficult physical and emotional battle against Alzheimer’s or other forms of dementia. Hospice serves those in the end stages of dementia, relieving pain, controlling symptoms, improving quality of life and reducing anxiety and worry for patients and their families.

VITAS meets the unique needs of patients with dementia who wish to remain wherever they live: in their home, long-term care facility or assisted living community. If the patient’s symptoms become too difficult to manage at home, VITAS inpatient hospice services are an option. On this page, we've provided answers to these questions:

• When is the right time to ask about hospice?
• What can hospice do for a patient with end-stage dementia?
• What can hospice do for the family or loved ones of a person with dementia?
• What are the overall benefits of hospice care?
• How can I approach the hospice discussion with my loved one(s)?

When to Consider Hospice for Late-Stage Dementia and Alzheimer's

Considering the slow decline of a patient with dementia, it can be difficult to determine when the time is right for hospice. In general, hospice patients are thought to have six months or less to live. Only a doctor can make a clinical determination of life expectancy. However, look for these common signs that the disease has progressed to a point where all involved would likely benefit from hospice care for end-stage dementia:

• The patient can say only a few words
• The patient can no longer walk and may be bed-bound
• The patient is totally dependent on others for eating, dressing and grooming
• The patient shows signs of severe anxiety

Are you a healthcare provider? Learn more about the clinical characteristics of end-stage dementia & Alzheimer’s and download a PDF of our hospice eligibility guidelines.

Request a Hospice Evaluation

The patient’s neurologist or personal physician may recommend hospice when the time is right. But as anyone who has faced a serious illness knows, patients and family members often must act as their own advocates to receive the care they need and deserve.

You, your loved one or your trusted physician may request an evaluation to see if hospice care for dementia is an appropriate option for care. Call 844.831.0028 to see how hospice can help.

What Can Hospice Do for a Patient with End-Stage Dementia or Alzheimer's?

Your hospice team evaluates the dementia or Alzheimer's patient's status and updates the plan of care as symptoms and condition change, even on a day-to-day basis. The goal of hospice is to relieve physical and emotional distress so end-of-life patients can retain their dignity and remain comfortable.

Hospice offers comprehensive services for patients with dementia and Alzheimer's, such as:

• Individualized care plan – As dementia progresses, patients lose the ability to express their needs. VITAS will design a plan that addresses pain, hydration, nutrition, skin care, recurrent infection and agitation—all common problems associated with dementia.
• Care for patients wherever they live – in their homes, long-term care facilities or assisted living communities. If symptoms become too difficult to manage at home, inpatient hospice services can provide round-the-clock care until the patient is able to return home.
• Coordinated care at every level – A plan of care is developed with the advice and consent of the patient’s neurologist or other physician. A team manager ensures that information flows between all physicians, nurses, social workers and, at the patient’s request, clergy. In addition, hospice coordinates and supplies all medications, medical supplies and medical equipment related to the diagnosis to ensure patients have everything they need.
• Emotional and spiritual assistance – Hospice has the resources to help patients maintain their emotional and spiritual well-being.

What Can Hospice Do for the Family of a Patient with Dementia?

As a patient enters the end stages of dementia or Alzheimer's, family members may have to make difficult healthcare and financial decisions, act as caregivers and provide emotional support to others. If the decision is made to stop medical support, families often experience strong emotions and feel overwhelmed.

Hospice offers comprehensive services for families of patients with Alzheimer's or dementia:

• Caregiver education and training – The family caregiver is vital in helping hospice professionals care for the patient. As the patient gets weaker, symptoms increase and communication becomes more difficult. We relieve families’ concerns by educating them on how best to care for their loved one.
• Help with difficult decisions – Hospice helps families make tough choices that impact the patient’s condition and quality of life—for example, whether to give antibiotics for a recurring infection.
• A VITAS nurse by phone 24/7 – Even the most experienced caregivers will have questions and concerns. With Telecare®, they don’t have to wonder, worry or wait for an answer. As the heartbeat of VITAS after hours, Telecare® provides trained hospice clinicians around the clock to answer questions or dispatch a member of the team to the bedside.
• Emotional and spiritual assistance – Hospice meets the needs of loved ones along with those of the patient.
• Financial assistance – Although hospice services are covered by Medicare, Medicaid/Medi-Cal and private insurers, families may have financial concerns brought about by their loved one’s extensive illness. Social workers can assist families with financial planning and finding financial assistance during hospice care. After a death, they can help grieving families find financial assistance through human services, if needed.
• Respite care – Caring for a loved one with an end-stage illness can cause tremendous stress. Hospice offers up to five days of inpatient care for the patient in order to give the caregiver a break. 
• Bereavement services – The hospice team works with surviving loved ones for a full year after a death to help them express and cope with their grief in their own productive way.

What are the Overall Benefits of Hospice Care?

You might have heard that hospice provides specialized medical care for patients and support services for loved ones, but most people are unaware of the many other benefits of hospice, such as:

• Comfort. Hospice works with patients and families to give them the support and resources to assist them through this challenging chapter of life and help them remain in comfortable and familiar surroundings.
• Personal attention. When the hospice team works with a patient or family, they become participants in the end-of-life process, a very personal experience for any individual. The hospice mission is to care for each person individually. We listen to patients and loved ones. We advocate for them. We work to improve their quality of life.
• Reduced rehospitalization. In the last months of life, some people who are seriously ill make frequent trips to the emergency room; others endure repeated hospitalizations. Hospice care reduces rehospitalization: a study of terminally ill residents in nursing homes shows that residents enrolled in hospice are much less likely to be hospitalized in the final 30 days of life than those not enrolled in hospice (24% vs. 44%)¹.
• Security. One of the greatest benefits of hospice is the security that comes from knowing that medical support is available whenever you need it. The VITAS Telecare® program assures healthcare support around the clock. And VITAS gives families the training, resources and support they need to give their ailing loved ones the care they deserve.

¹ Miller SC, Gozalo P, Mor V. Hospice enrollment and hospitalization of dying nursing home patients. American Journal of Medicine 2001;111(1):38-44

How Can I Approach the Hospice Discussion with My Loved One(s)?

The final months and days of life are frequently marked by strong emotions and hard decisions. Talking about hospice, even with those closest to you, can be difficult. Here are some tips to get the discussion going.

For Patients Speaking to Families

• Education is key. Educate yourself first. By now, you’ve probably done some research on this website. It might also be helpful for you to learn some common misconceptions about end-of-life care, as your family may be misinformed about the realities of hospice. Read and share our Hospice Family Discussion Guide for some guidance.
• Determine what your loved ones know. Before bringing up hospice, make sure your loved ones have a clear understanding of your health status. People handle difficult information in different ways. If family members are not accepting or understanding of your prognosis, you might want to have your physician, clergy or a trusted friend speak with them on your behalf. 
• Discuss your goals for the future, as well as theirs. As a patient, your greatest concern might be to live without pain, or to stay at home, or to not become a burden. Ask your loved ones what their concerns are when they consider the coming months, weeks and days. Explain that hospice is not giving up. It is an active choice to ensure that everyone’s needs are met. 
• Take initiative. Remember, it’s up to you to express your wishes. Sometimes, out of concern for your feelings, your family or loved ones might be reluctant to raise the issue of hospice for you. 

For Families Speaking to Patients

• Do your research. You've already started by visiting this website. Be prepared to answer some of your loved one's questions about end-of-life care, treat their feelings with respect, and address misconceptions they may have about hospice. Our Hospice Family Discussion Guide can help you prepare for this conversation.
• Ask permission. Asking permission to discuss a difficult topic assures your loved one that you will respect his or her wishes and honor them. Say something like, “I would like to talk about how we can continue to ensure you get the very best care and attention as your condition progresses. Is that okay?” 
• Determine what is important to your loved one. Ask him or her to consider the future: “What are you hoping for in the coming months, weeks or days? What are you most concerned about?” The patient might express a desire to be comfortable, to stay at home or to not become a burden. 
• Discuss hospice care as a means of fulfilling the patient’s wishes. Now that your loved one has told you what is important to him or her, explain that hospice is a way of making sure wishes and desires are met. For some, the word hospice evokes a false notion of giving up. Explain that hospice is not about surrendering to disease or death. It is about bringing quality of life to the patient’s remaining months, weeks or days.
• Assure the patient that he/she is in control. Hospice gives patients options: the option to remain in the comfort of their own home, the option to take advantage of as much emotional and spiritual support as they desire, the option to have their own doctor actively involved in their care. Reassure your loved one that you will honor his or her right to make choices about what is most important in life.
• Be a good listener. Keep in mind that this is a conversation, not a debate. Hear what the other person is saying. Know that it is normal to encounter resistance the first time you talk about hospice care. But if you listen and understand your loved one’s barriers and reasons for resisting, you will be prepared to address and ease his/her concerns in your next hospice discussion.