DIMENSIONS Winter 2000


Q. My dad has advanced AD, and my mother needs help taking care of him. Could he be enrolled in a hospice care program?

A. Hospice care is a service available to people who are terminally ill and their families for end-of-life comfort care. Jan Williams, director of hospice care at Swedish Medical Center explains, "Comfort care means that hospice workers try to manage the patient's symptoms and pain, to make the patient as comfortable as possible and avoid infection, without trying to 'fix' the problem or restore health." In general, hospice tries to help the patient and family address all of the issues that arise at the end of life including physical symptoms, caregiving, emotional and spiritual support. Hospice consists of a broad team of professionals including a medical director, nurses, social workers, home health aides, chaplains and volunteers.

When a person has Alzheimer's disease, it may be difficult to know when hospice care is a viable option, since the duration and rate of decline varies so greatly. In general, a person with advanced AD is eligible for hospice care. Specifically, this means that: 1) The person is unable to walk or dress him/herself without assistance, likely incontinent, and unable to have meaningful verbal communication; and 2) In the last 12 months the person has had severe medical symptoms such as aspiration pneumonia, multiple pressure ulcers, recurring fevers, or has lost at least 10% of his/her total body weight. The patient's physician must certify that the person meets the eligibility criteria for hospice.

Hospice care is covered 100% by Medicare and Medicaid, as well as most private insurance companies, throughout the duration the person is certified by the physician as eligible and as long as the family wants to focus on comfort care. The average length of time individuals are on hospice is about 40 days, but it can range from many months to a couple of days.

Choosing comfort care for a loved one can be a difficult and emotional decision. Families must consider the person's medical status as well as his/her quality of life, needs and wishes. Hospice can help families make informed decisions, as well as provide a network of support and care. For more information on hospice care, contact the Washington State Hospice Organization at (888) 459-0438 or http://www.nho.org, or the Home Care Association of Washington at (425) 775-8120.

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