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    When to consult hospice in end-stage Alzheimer’s disease

    Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Lori E. Rousche, MD, a family physician in Souderton, Pennsylvania. She is also the hospice medical director for Grand View Health in Sellersville, Pennsylvania. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.


    Hospice consults for end-stage Alzheimer’s Disease will improve the patient’s quality of death, decrease end-of-life care burdens for families and nursing home staff, and save Medicare and Medicaid money. What’s not to like? Physicians and their extenders should consider involving hospice when the dementia has advanced to its last stages.


    More from Dr. Rousche: Hospice consultation should be a quality metric


    Alzheimer’s Dementia is a progressive neurologic disease that affects an estimated 5.5 million patients in the United States. It is an unbearably difficult disease for patients and families alike. We all have patients who are caregivers to a parent or spouse with this ugly disease, and know how challenging it can be. The caregivers can frequently become overwhelmed and depressed. As a patient with Alzheimer’s reaches the end-stage of the disease, they often don’t know their family members’ names, need to be fed and are incontinent of bowel and bladder. They will no longer even be able to hold their head up while in a seated position. These patients require total assistance, and it is not an easy road for the committed spouse, son or daughter.

    The emotional costs are devastating, but so are the monetary costs. According to the Alzheimer’s Association, in 2017, the estimated cost of caring for those with Alzheimer’s (and other dementias) in the United States will total approximately $259 billion. More telling is a recent study which found that in the last five years of life, the costs of a person with dementia totals more than $287,000 (Compare that to the estimated cost of raising a child from birth to eighteen years old of $233,610). Most of these costs are covered by Medicare and Medicaid. In 2017, Medicare and Medicaid will spend approximately $175 billion caring for those with Alzheimer’s and other dementias, which is a big portion of their total budgets.


    Further reading: Top facts physicians need to know about hospice care


    Hospice is a covered Medicare service that allows patients to die with dignity. It also provides added family/caregiver support, volunteer services and bereavement help. A hospice consult is a gift to every end-stage Alzheimer’s patient. So, when should you, as the primary provider, ask for a hospice consult? The following is a breakdown of what makes a patient eligible for hospice care in end-stage Alzheimer’s disease.  

    Next: Make sure to follow this criteria


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