By Dr. Ileana Leyva
As a progressive neurodegenerative disease, Alzheimer’s requires substantial help from caregivers. From bathing to feeding to other activities of daily living (ADLs), caregivers stepped in to provide an estimated 18 billion hours of care last year for loved ones with Alzheimer’s and related dementias. These 11.4 million caregivers were unpaid.1
How do we lighten the burden for family caregivers without shifting it to already-stressed healthcare settings? For patients who no longer respond to optimized therapies and show increased functional decline, hospice may be the answer.
Hospice supports caregivers by offering clinical and psychosocial expertise to manage patient symptoms. This next-level care provides complex modalities for those who require high-acuity care and includes integrative services to enhance their quality of life.
The hospice team works alongside caregivers to provide psychosocial support, community resource connections, and respite services. Caregivers receive immediate, ongoing grief and bereavement support, reducing depression and anxiety and contributing to better overall health.
Reducing Hospital Readmissions and Saving Significant Costs
Evidence supports the benefits of hospice for patients with dementia and their caregivers.2 The patient is more likely to die at home and have greater satisfaction with their care. Research indicates a 50% reduction in hospitalizations, with better pain and symptom management and fewer care transitions.
Studies also show that hospice-enrolled people living with dementia had a higher quality of life compared to those without hospice, and end-of-life transitions were significantly lower. For those in hospice in the last month of life, 68% reported their anxiety/sadness as managed, and 55% believed they received excellent quality of care.3
At the same time, hospice yields significant savings. A recent NORC at the University of Chicago study found that patients who chose hospice care saved Medicare approximately $3.5 billion in a single year.4 Further, patients with neurodegenerative disease who had hospice stays of 180 days or greater reduced Medicare costs by 4% compared to non-hospice users.
With the rise in Alzheimer’s diagnoses, these savings multiply. By 2025, the Alzheimer’s Association projects 7.2 million people ages 65 and older will have Alzheimer’s disease.1
Discovering Preferences: Initiating Goals-of-Care Conversations
For Alzheimer’s and dementia patients, poorly defined goals lead to unwanted treatments, undue suffering, and misuse of resources.
While clinicians in busy settings like hospitals have limited time, it’s possible to conduct rapid palliative assessments and have efficient goals-of-care conversations when patients are initially diagnosed—while they have decision-making capacity.
Involve their family caregivers as well. As the disease progresses, these caregivers will make the decisions as they seek to fulfill the patient’s wishes and values.
What Makes a Patient With Alzheimer’s/Dementia Hospice Eligible?
Patients become eligible for hospice when they receive a prognosis of six months or less to live. Those with Alzheimer’s disease who lose the ability to communicate meaningfully, and other dementia patients who become dependent in three of six ADLs (bathing, dressing, continence, transferring, ambulation, feeding), plus have either of the following, may be eligible for hospice:
- A comorbidity resulting in structural/functional impairment (e.g., heart disease/advanced lung disease)
- A clinical complication indicating disease progression (e.g., febrile episode, infection requiring antibiotics, pressure ulcers, dehydration, weight loss, eating difficulties, delirium, feeding tube)
In these cases, hospice enables patients to remain in the comfort of their home—while easing the strain on family caregivers.
Experts at VITAS can help guide goals-of care conversations. To make referrals or find out more, contact VITAS at (800) 93-VITAS or VITAS.com/referrals.
Dr. Ileana Leyva is Regional Medical Director, VITAS® Healthcare.
1 Alzheimer’s Association. (2023). 2023 Alzheimer’s Disease Facts and Figures. Retrieved from https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pd
2 Shega, J., et al. (2008). Patients Dying with Dementia: Experience at the End of Life and Impact of Hospice Care. Journal of Pain and Symptom Management, 35(5), 499-507.
3 Harrison K., et al. (2022). Hospice Improves Care Quality For Older Adults With Dementia In Their Last Month Of Life. Health Affairs, 41(6), 821-830.
4 NORC at the University of Chicago (2023). Value of Hospice in Medicare. Available at: https://www.nhpco.org/wp-content/uploads/Value_Hospice_in_Medicare.pdf
