Hospice won't accept non-Alzheimer's dementia patients?

jsohio

Has anyone encountered a hospice program that will not accept non-Alzheimer's dementia patients covered by Medicare? One of our local hospice programs evaluated my wife (who has vascular dementia) but would not accept her because - according to them - "Medicare will not cover hospice care for dementia patients unless they have been diagnosed with Alzheimer's."

harshedbuzz

I have 2 aunts with VD who had Medicare-funded hospice at the end-of-life. Both were in a facility which suggested the initial evaluation. 

My friend's mom at home who was diagnosed with "unspecified dementia" as she was quite old and the family didn't feel she needed to be put through testing beyond a CT scan and bloodwork with her Internal Medicine doctor also had hospice care for her last 8 months.

If your wife meets the general criteria in terms of progression, I would call a different/more capable provider.

HB

M1

Hi jsohio. I'd call another program if there's another in your area.  Ability to do activities of daily living--walking, toileting, inability to eat causing weight loss--should matter more than diagnosis I should think.  There are several threads on these boards about people being rejected by one agency but accepted by another.

Jo C.

Hello jsohio; I am so sorry that you were given incorrect information; that is simply not true.  Medicare Hospice benefits are for all of the dementias - BUT -  that being said, the Medicare criteria for admssion to Hospice under a dementia diagnosis is extremely hard to meet.  Very often, an intake RN from Hospice will admit the patient under a different medical diagnosis that may be present other than dementia to be able to serve a patient with Hospice needs when the strict, very outdated criteria for dementia cannot be met.

(Dementia is an umbrella term for ALL dementias including Alzheimer's Disease as Alz's is simply one form of dementia.) 

The following link shows what criteria must be met in order to get admitted to Hospice under a dementia diagnosis.

https://www.compassus.com/healthcare-professionals/determining-eligibility/hospice-criteria-alzheimer-dementia

It is also important to know that Hospice organizations can be different from one another in how beneficent they are; some are far more accepting than others. It is also true that the Intake RNs can differ with some being knowledgable and excellent at what they do and others being deficient and lacking in skill and knowledge which can make or break having a patient accepted into service.

It really is true that most Hospice Intake RNs seeing a patients needs being appropriate for service will work diligently to get that patient accepted; as said, often using other medical conditions to get admission when the stringent and outdated dementia criteria is not met.  As said, the federal agency making the decision for admission criteria for Hospice, which I think is the CMS, really needs to go back and revisit the criteria for dementia admission to Hospice and get it adjusted. Shame on them.

So . . . what I would advise is to contact a different Hospice and have another intake done.  NOTE:  In my personal and professional experience, the larger Hospice entities are far more accepting and better able to deal with patient care needs than are the small "Mom and Pop" type of entities.

You do NOT need a doctor's order to call a Hospice out to screen a patient.   If the screening is successful and the patient acceptable for Hospice admission, the Hospice RN will call the physician and get an order for admission into service which is required to intitate care . . . it is nothing you will have to do, it is all done for you.

Please let us know how things are going at home, how you are doing and how this all works out for you. We will be thinking of you and we truly do care.

J.

May flowers

Hospice is covering my FIL who has vascular dementia. Sounds like it may be that agency’s policy.

Our hospice agency told us a few different times “Medicaid won’t pay for that” but when I did my homework, I found Medicaid did indeed cover it, so the agency just didn’t want to deal with it for whatever reason. I’m learning to be a bit of a “squeaky wheel” with this agency. If I didn’t love the nurse and CNA, I would have switched long ago.

Rescue mom

I would absolutely check with other Hospices; this really sounds like something this one hospice is using as a “reason.” Other hospices often have different policies. 

The hospices my mom was with,  took all kinds of dementia patients.

That said, dementia alone—nor any of its varieties alone—was not enough to be accepted, IME.  There always had to be another, more “physical” reason, such as weight loss, mobility problems, wound healing problems, and so forth. The hospices would accept patients with dementia  (and usually things they did also helped with the dementia) but there had to be these other conditions, not just a dementia or cognitive/behavior issues, to be accepted.

My mom, BTW, had a dementia and was in and out of several hospices over a few years. She’d be admitted for things like weight loss or mobility problems, then she’d get better on those, and have to “graduate” or leave Hospice for a while. Her dementia remained and progressed, as they do. Then another physical problem happened, and she’d go go back in hospice. But what hospice did for her official issues, also usually was a help with the dementia.

At any rate, if one hospice doesn’t take, I say ask another. No harm in asking, nothing to lose.