End-Stage Dementia

The patient has dementia, which has progressed to:

• Stage seven or beyond according to the Functional Assessment Staging Scale
• Unable to ambulate without assistance
• Unable to dress without assistance
• Unable to bathe without assistance
• Urinary and fecal incontinence, intermittent or constant
• No meaningful verbal communication, stereotypical phrases only, or ability to speak is limited to six or fewer intelligible words and

Patients must have had one of the following within the past 12 months:

• Aspiration pneumonia
• Pyelonephritis or other upper urinary tract infection
• Septicemia
• Decubitus ulcers, multiple, stage 3 – 4
• Fever, recurrent after antibiotics
• Inability to maintain sufficient fluid and calorie intake with 10% weight loss during the previous six months or serum albumin < 2.5 gm/dl

A physician may determine that a patient has a life expectancy of six months or less even if the above findings are not present. Co-morbidities also support eligibility for hospice care.