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How Are Patients With Dementia Certified and Recertified for Hospice?
A functional assessment staging tool, or FAST Scale, is used to identify functional abilities of those with Alzheimer’s or types of dementia. Items are scored based on clinical analysis or […]
A functional assessment staging tool, or FAST Scale, is used to identify functional abilities of those with Alzheimer’s or types of dementia.
Items are scored based on clinical analysis or information obtained from a knowledgeable informant and include:
- Subjective work difficulties
- Decreased ability to perform complex tasks (dinner planning, paying bills, etc)
- Improperly putting on clothing without assistance or prompting
- Unable to bathe frequently or properly without assistance
- Urinary and/or fecal incontinence
- Unable to speak more than a half-dozen intelligible words or fewer in the course of one day
- Limited ambulatory ability (cannot walk without personal assistance)
- Cannot sit up without assistance
- Loss of ability to hold up head without assistance or prop
Aside from this score, other dementia-related eligibility criteria, like the presence of co-morbid disease or secondary conditions, are considered in whether hospice is warranted.
While some patients with end-stage dementia steadily decline and receive benefits indefinitely, others who do not meet criteria at the prescribed 30, 60, or 90 day intervals are often discharged from hospice. This is due in part to a policy implemented in 2014 by the Center for Medicare and Medicaid Services that decreased Medicare reimbursement for patients who are in hospice for greater than 60 days. Unfortunately, the patient population that accounts for the most lengthy hospice stays is those with some form of dementia, so these patients are more likely to be discharged while alive. According to research published in the Journal of American Geriatrics Society, nearly 40% of dementia patients in hospice in 2019 were discharged while alive. This is possibly due to improvement in the patients’ functional abilities, but may also reflect the reluctance of hospice providers to continue caring for patients once reimbursement declines.
Sources
“Functional Assessment Staging Tool (FAST Scale) for Dementia”. Compassus. https://www.compassus.com/healthcare-professionals/determining-eligibility/functional-assessment-staging-tool-fast-scale-for-dementia/
“Survival in hospice patients with dementia: the effect of home hospice and nurse visits”. Journal of American Geriatrics Society. https://pmc.ncbi.nlm.nih.gov/articles/PMC8192457/
