Hospice care is a type and philosophy of care that centers on easing the pain and symptoms of a terminally or seriously ill patient and attending to that patient's emotional and spiritual needs. At end-stage Alzheimer's disease, the goal of hospice is to keep that person as comfortable as possible

Hospice care is provided by a team of professionals, which may include a medical director, the attending physician, nurses, social workers, counselors, clergy and home health aides. Once hospice care is ordered by the physician, and the patient is enrolled in that care, the team meets regularly to evaluate and coordinate a plan of care. One member of the team is available 24 hours a day to address issues and concerns.

Hospice care can be offered in a home, nursing home, assisted living facility or an in-house hospice care facility.

Because the span of Alzheimer's disease can run from seven to 20 years, it is often difficult to know when hospice care is warranted.

Generally, a hospice referral is issued when someone with Alzheimer's: is severely impaired when walking and eating, becomes incontinent, experiences frequent choking episodes or has difficulty breathing, is unable to speak or communicate meaningfully, or has significant weight loss.

With the progression of the disease, other conditions are also associated in the late stages such as aspiration pneumonia, urinary tract infection, septicaemia and decubitus ulcers. Health conditions such as cardiovascular disease or congestive heart failure, lung disease, strokes, diabetes, renal failure and cancer also could significantly impair the affected patient's health and functionality.

The decision for hospice is made when the goals of the patient and family members are palliative and not life-prolonging. The criteria for acceptance into hospice care include: diagnosis by a licensed physician as having end-stage Alzheimer's, with limited life-expectancy (six months or less); residing within the specific geographic boundary of the hospice service; and consent by the family/caregiver of the affected person.

Medicare, Medicaid and many private insurance policies cover hospice care costs.

In choosing a hospice provider, you would want to consider the provider's services and reputation, if the staff is specifically trained in Alzheimer's disease and the plan of care developed by the staff. You can also ask if the hospice provider is licensed by the state or accredited by a licensing organization, such as the Joint Commission on the Accreditation of Healthcare Organizations.

To find more about hospice care programs, visit the Louisiana/Mississippi Hospice and Palliative Care Organization, lmhpco.org, or the National Hospice and Palliative Care Organization, nhpco.org.

Questions about Alzheimer's disease or related disorders can be sent to Dana Territo, the Memory Whisperer, owner of Dana Territo Consulting, LLC, at thememorywhisperer@gmail.com.