Hospice of Michigan

END-STAGE DEMENTIA

The patient has dementia, which has progressed to:

• Stage seven or beyond according to the Functional Assessment Staging Scale
• Unable to ambulate without assistance
• Unable to dress without assistance
• Unable to bathe without assistance
• Urinary and fecal incontinence, intermittent or constant
• No meaningful verbal communication, stereotypical phrases only, or ability to speak is limited to six or fewer intelligible words and

Patients must have had one of the following within the past 12 months:

• Aspiration pneumonia
• Pyelonephritis or other upper urinary tract infection
• Septicemia
• Decubitus ulcers, multiple, stage 3 – 4
• Fever, recurrent after antibiotics
• Inability to maintain sufficient fluid and calorie intake with 10% weight loss during the previous six months or serum albumin < 2.5 gm/dl

A physician may determine that a patient has a life expectancy of six months or less even if the above findings are not present. Co-morbidities also support eligibility for hospice care.

Caring for a Loved One with Advanced Dementia

A Guide for Families and Caregivers

Alzheimer’s disease and other types of dementia are one of the major causes of debility and death in the elderly. Knowing what choices to make when a loved one is in the end stages of life while suffering advanced dementia is one of the most difficult issues facing family care givers. Hospice of Michigan has produced a unique resource to guide families to the answers they need.

In fall 2005, HOM issued the second edition of “Caring for a Loved One with Advanced Dementia,” the first-ever guide for families of individuals with advanced dementia and in need of hospice care. The first edition of the manual was distributed to 10,000 families in Michigan and was winner of the National Hospice and Palliative Care Organization’s “Excellence in Education” Award.

The manual grew out of an on-going research program, Palliative Excellence in Alzheimer’s Care Efforts (PEACE Project), and is based on HOM experiences in caring for more than 1,500 dementia patients over the previous six years. It was developed to help families prepare for and confront the difficult issues they will face as their loved one reaches the advanced stages of dementia, when medical interventions such as feeding tubes, ventilators, CPR and medications can be more painful and disruptive than helpful.

The manual guides caregivers in asking the right questions to determine whether or not to treat infections, insert a feeding tube, or use CPR if the patient goes into cardiac arrest. It helps them decide if comfort care, rather than aggressive treatment, is the best choice.

The manual is a project of the Maggie Allesee Center for Innovation (MAC). The cost is $8.50/manual, plus shipping. Click the link below to order the booklet from the MAC Shop.

- MAC Online Store -