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Hospice eligibility · disease-specific

Hospice eligibility: dementia (Alzheimer's and related)

Dementia is one of the most common hospice diagnoses and also one of the most under-documented at admission. Eligibility centers on the FAST scale, comorbid complications, and clear decline.

By Goodwin Hospice Academy Editorial Team·Grounded in MAC Dementia / Alzheimer's LCD·Published February 16, 2026

Educational content only. Individual clinicians must confirm current LCD language with their MAC and defer to the hospice medical director for eligibility certification.

Quick criteria

  • FAST Stage 7 (unable to ambulate without assistance, unable to dress/bathe, incontinent).
  • Speech limited to ≤ 6 intelligible words per day.
  • At least one comorbid complication in the past 12 months (aspiration pneumonia, UTI with sepsis, pressure ulcer stage 3-4, fever after antibiotics, unintentional weight loss > 10%).
  • Albumin < 2.5 g/dL (if measured).
  • Documented functional decline over prior 6 months.

Documentation example

A composite narrative illustrating how the LCD framework maps to a real hospice admission (identifying details fictionalized):

Patient is an 88-year-old with advanced Alzheimer’s dementia, FAST 7c (nonambulatory), incontinent of bowel and bladder, aphasic (2 intelligible words/day), one hospitalization for aspiration pneumonia and one for UTI with sepsis in past 6 months, stage 3 sacral pressure injury, weight loss 15% over 6 months.

Workflow for a defensible admission

  1. 01Score FAST at admission and each recertification.
  2. 02List every comorbid complication with dates (aspiration, UTI, pressure ulcers, fever episodes).
  3. 03Document weight and weight change over 6 months.
  4. 04Note swallowing status and current feeding route.
  5. 05Reference the MAC dementia LCD in the narrative.

FAQ

Is FAST 7 required for hospice eligibility?
The MAC dementia LCD generally supports FAST 7 plus a comorbid complication. Some patients may qualify below FAST 7 with strong comorbid decline documentation, but FAST 7 is the safest starting point.
What if the patient is still eating?
Weight and weight-change documentation is more important than the presence or absence of eating. Weight loss > 10% over 6 months supports eligibility.
Are behavioral symptoms considered?
Yes. Persistent, distressing behavioral symptoms (agitation, calling out, resistance to care) support the plan of care but do not on their own establish eligibility — the FAST stage and comorbid complications do that.

Turn this into a defensible chart.

Use the free Hospice Eligibility Checklist to walk this framework interactively. Copy the paste-ready documentation summary directly into your narrative note.

Open eligibility checklist Benefit Period Calculator

Related conditions

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Stroke / coma

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Parkinson's disease (advanced)

Eligibility

Neurological disease (non-ALS, non-Parkinson’s)

Related reading

Article

What is HOPE?

Article

Hospice Eligibility Checklist

Sources

  1. CMS Medicare Coverage Database (MAC Dementia / Alzheimer's LCD)
  2. CMS Medicare Benefit Policy Manual, Ch. 9
  3. 42 CFR §418 — Hospice Conditions of Participation

Educational content only. Not a substitute for your organization’s policies, your medical director’s clinical judgment, or current MAC LCDs.