Alzheimer’s Disease and other forms of dementia offer a challenge to Hospice in eligibility for Medicare coverage and for the care given. 

In Alzheimer’s Disease there is chronic phase and a terminal phase.  It is during the terminal phase that the patient becomes eligible for hospice. 

Because patients live for a long time with increasing disability, families (and, often, professional caregivers) find it hard to know when a person is in the last phase of illness. The Alzheimer's Association offers educational programs for families advising them of their right to choose hospice care. Medicare's hospice benefit is available to persons who live in nursing facilities provided that they are not relying on Medicare to support their nursing home costs and a hospice program has worked out the arrangements with the nursing facility.

To be eligible for Medicare coverage, a person must:

• Have a terminal illness—estimated at six months, if the disease continues to follow the same course.
• Choose palliative (comfort) over curative or life-saving treatments.

A doctor must certify that the person has a limited life expectance of six months or less, or as long as the disease runs its normal course.

Hospice care follows a palliative approach to care, but includes much more, such

as spiritual and grief counseling, coverage for certain medications and supplies,

and in some areas expert medical consultants certified in palliative medicine.

Facilities may provide “comfort care” but if they aren’t licensed hospice providers

they may not provide the comprehensive range of benefits that eligible patients

and families deserve.

Decline in dementia patients is often misunderstood. If basic eligibility is met,

hospice services continue even if there are weeks or months of stability. Since

true dementia patients don’t “improve” in terms of regaining lost function, loss of

hospice eligibility is not an issue.