How do you know when it's time to ask for/involve hospice for Alzheimer's cases?

Hospice nurses have seen so many people who are non-verbal that they can tell when someone is distressed and track down that cause. There is someone on call 24/7 if something happens. I had told Hospice not to call me during sleeping hours unless it was life threatening, so when mthr fell and broke her wrist, Hospice was the one getting up in the middle of the night, assessing the situation, and handling it the way we discussed before it happened. As a result of the fall, they moved her ottoman, her favorite hidey-hole, into her closet where she can still use it but she's not tempted to climb on it. (she can barely walk, I have no idea how she was climbing!)

They have her on drugs which stabilize her mood and keep her from being so paranoid and anxious. The doc had her on a mishmash of dru,gs some of which he'd thought he'd stopped and she was so confused. Hospice has her meds straight and checks them from the pharmacy. It is such a relief to have someone else checking these things!

It's her doctor who has to certify that she's eligible for hospice. Call him and set up an appointment to discuss if this is an appropriate move.

Sophe, Your mil is about where my mthr is... Hospice comes to her memory care and checks her out for signs of UTIs and other ailments, straightened out her meds, and helped us make final arrangements in advance. When she fell, they brought out the mobile xray unit so she did not have to go to the ER where she would have been out of her mind with fear. Hospice managed her meds through that painful break and she never had to leave her space. There are about 8 other hospice patients in her MC home out of about 20, so they bring in lots of performers - instruments, vocalists, they even have hospice activities separate from the MC activities. Hospice has been wonderfully helpful, and the counselors even help the grandchildren.

Both my mother and my husband have/had dementia. Generally, the applicant has to be in a condition that would typically result in death within 6 months. Some types of cancer can be fairly accurately pinpointed this way. Dementia is much harder. From my experience I'd recommend involving hospice if her doctor thinks it is appropriate.

I signed my husband up when he began to physically go downhill, sleeping more and more, having trouble swallowing, getting too weak to walk. He was at home at the time. I can't tell you how wonderful it was to have medical attention come to him. There were several conditions they solved immediately. The nurse even came up with something to minimize his constant drooling. He definitely was more comfortable and dignified with hospice care. He died after five weeks, holding my hand.

My mother is in a nursing home. A few months after being there she broke her hip and became delirious. The hospital didn't expect her to survive the week. She went back to the NH with hospice care. She got lots of extra attention, a very comfortable wheelchair, a special bed, volunteers spent time with her, doing things like giving her gentle hand rubs, and doing her nails or fixing her hair. Hospice took over her medications, and it was very easy to work directly with the nurse. Hospice is awesome for cutting through red tape. After three months my mother "graduated" out of hospice. She improved enough so there was no reason to believe her death was imminent. (In her mid 90s it isn't far into the future, but not within 6 months, as far as anyone can tell.)

Since your MIL has nothing "fixable" I don't see any downside at all to involving hospice. (If she had to decide to forego chemo, it might be a tougher decision.) If she is on the final leg of her journey, hospice can make it smoother for all of you. And if that prognosis is wrong, she can leave hospice and come back to it when it is more appropriate.

As to communicating with her, hospice could help you with that, too. Remember that even if she doesn't know exactly who you are, she will know that a kind person is visiting and treating her nicely.

Hi I am sorry about all you are going through. With my mom, when I felt hospice might be helpful, I just called. They came out for an evaluation. And in their opinion they felt that hospice was necessary. At that point, they contacted my mom's doctor and he cancelled the medicare nurses that had been coming to visit her and moved her to hospice care. Now here is the important thing....I thought I was being smart in keeping my mom's doctor as her primary, not giving hospice's doctors that role as I did not know them. The problem arose when at the end, my mom needed morphine etc to keep her comfortable and her regular doctor would not prescribe those meds.....so we were in a bit a hectic rush getting her transferred to the hospice doctors so he could give her the morphine to help her breathe better. So getting an evaluation by hospice is always a good first step.

Have your doctor call in hospice.... my doc asked which one I wanted, for my husband in assisted living with alzheimers. Hospice came in, asked me lots of questions, checked husband, and THEY made the decision. Said every six months they would re evaluate him. Sadly, he didn't even last that long under their care. In the home end of May 2014, hospice came in end of July, and he died early November. I agree, it was so nice not to get a call in the middle of the night, asking me what I wanted to do! Hospice was called first, they took care of his meds and eliminated many. They checked him 3 times a week, made his bed, bathed him. I could call and asked a question anytime of day or night, very helpful. Bob could not speak either, no communication of any kind... since 2009. Hospice here was just The Best.

The six month rule has never applied as long as the patient continues to decline. the hospice has to provide evidence to Medicare about the patient's condition,such as weight loss, inability to eat etc.

Medicare guidelines for hospice stipulates that a physician certifies that an individual has a prognosis of 6 months or less if the disease runs its normal course. When determining eligibility, hospice personnel looks the big picture, incorporating all diagnoses and how they play a part in the terminal diagnosis (such as Dementia).
The basic indicators include progression of disease (infections, weight loss, difficulty swallowing, weakness, change in level of consciousness) as well as a decline in the Palliative Performance Scale, dependence with activities of daily living and disease specific guidelines.
Disease specific guidelines for Dementia include a FAST (Functional Assessment Staging Scale) of 7A with contributing factors such as sepsis, wounds and malnutrition. A FAST of 7A presents with inability to ambulate, dress or bathe independently, incontinence and limited speech (6 words or less).
It is best to have your mom evaluated for eligibility, as these are only guidelines. If your mother-in-law doesn't qualify for hospice, a palliative care program may be a good option. Palliative care can be supportive of you and your mom through this difficult disease and personnel have a good idea when it is the right time for hospice.

The six-month limit doesn't apply any more for hospice care. It can be longer is the patient meets certain criteria. A hospice rep in your area can explain it.

Well your mother cannot have hospice without a doctor's orders. Speak to the doctor again with definite answers. The time is coming, perhaps not just yet.