This is another thought provoking article from The New Old Age blog at The New York Times. When hospice-eligibility hinges on a “six months to live” prognosis, what do you do about adults with advance dementia? Individuals with advanced dementia can live years, but because their prognosis is less certain than, say, someone with heart failure, many are not being enrolled in pain-management care. Learn more about the issue below and share your thoughts in the comments. -SP
End-of-Life Care for Patients With Advanced Dementia
By PAULA SPAN
It’s hard for physicians to determine with much precision how long anyone with a terminal disease can expect to live, but it’s particularly challenging when the disease is advanced dementia.
“People with dementia get sicker inch by inch,” said Lin Simon, director of quality at Gilchrist Hospice in Baltimore, the largest hospice organization in Maryland. “Trying to say, ‘Now, she’s ready for hospice’ is much harder.”
Yet doctors serve as the gateway to hospice, which provides palliative care for the dying and support for their families. Medicare regulations require a physician to certify that a patient entering hospice is likely to die of his or her disease within six months. Doctors are more likely to do so when the disease is cancer or heart failure, which have more predictable trajectories.
That’s the major reason that dementia patients — who can benefit from the better pain control, fewer hospitalizations (so often associated with aggressive treatments that confer no measurable benefit) and greater family satisfaction that hospice has been shown to provide — are under-enrolled in hospice programs.