I had a very interesting conversation with someone yesterday. She works for the Alz Assn and received a call telling her about someone with EOAD (now deceased) whose wife said she had difficulty getting approval for hospice based on her husband's age. This didn't make sense because even children can be approved for hospice.
So that raised several questions:
--How do EOAD and the other younger onset dementias progress in the late stage? Does the presence of dementia in a younger person, presumably healthier in a physical sense, progress any differently?
--If so, does this delay or prevent approval for hospice?
Marilyn, my husband was diagnosed at age 49...was first approved for hospice care at the age of 57. Subsequently he was dropped by them after 18 months because he had "stabilized"! Then he was reapproved at 61 about four weeks before he died.
I can only speak for our case, but my husband progressed through all the stages of the disease. I do believe that his young age and his healthy body kept him in Stage 7 for five years.....bedridden, contracted and almost vegetative.
That's a good question about eoad progression. I have a friend whose husband was diagnosed in his mid thirties. He rapidly went down hill and after 3 years then he was bed ridden. She continues to work full time, raise her children, and care for him at home with help from aids. He has been bed ridden for 5 or 6 years now.
One the other hand my FIL took my MIL to Scotland less than a year before she passed. Her progression was moderate at first, then a fairly rapid decent. She died less than two weeks of nursing home placement.
My husband was diagnosed over three years ago and is in a clinical study. He's still doing fairly well. He still runs 6 miles a few times a week and maintains the house and yard.
Progression is the same as everything else about Alzheimer's Disease - "You've seen ONE Alzheimer's patient, you've seen ONE Alzheimer's patient." There are similiarities (as we all know from our discussions), but every single person is affected differently and progresses differently.
Hopsice evaluation differs in each State. Florida gives a bit more latitude than other states, but generally, if you have a terminal disease, and less than 6 months to live, you are eligible for Hospice. It should not matter how old you are - if you are in Stage 7, you should be eligible. But they do re-evaluate, as Sandi said, and if the person has not died in the 6 month period, it is up to Hospice whether to drop or extend.
To expand your last statement Joang--"...it is up to Hospice whether to drop or extend." using parameters specified by Medicare...
We re facing this now. Our Case Manner and our aide both are totally frustrated becuse they can see DH's currently progressing declines, but becuse they aren't in the "required areas" it's nearly a sure thing he'll be dropped for now.
She told me that in cases like this they keep in touch and all it will take is a significant event or change and I can get them right back. Basically, it amounts to him declining in the wrong areas. They are applying rules for diseases like cancer to dementia cases---apples vs oranges, you know.
The oddest thing is that two Hospice Agencies in the same city will have different requirements for admission. In our case, we were turn down flat on a Friday and accepted whole heartedly on the following Monday by a different agency.