For physicians, nurses and discharge planners
What is the FAST scale in hospice?
The Functional Assessment Staging tool (FAST) stages Alzheimer's-type dementia from 1, no difficulty, to 7f, unable to hold up the head, by the function lost in the order it is usually lost. The Medicare hospice LCD guidance looks for stage 7 or beyond, with all of its findings, plus one complication in the past 12 months. Beta Hospice in San Bernardino stages it at the evaluation visit.
Medically reviewed by Oscar Chien, MD, Medical Director, October 26, 2026
On this page (4 sections)
What are the FAST stages?
The Functional Assessment Staging tool stages Alzheimer's-type dementia by lost function, in the order the losses usually occur. Stage 7 is split into substages 7a to 7f. Described here in plain words after Reisberg (1988).
| Stage | What the person can and cannot do |
|---|---|
| 1 | No difficulty, subjectively or objectively |
| 2 | Complains of forgetting where objects are; subjective work difficulty |
| 3 | Decreased job function evident to co-workers; difficulty travelling to new locations |
| 4 | Decreased ability to perform complex tasks, such as planning dinner for guests or handling finances |
| 5 | Needs help choosing proper clothing for the day, season or occasion |
| 6a to 6e | Needs help putting on clothes (6a); bathing (6b); the mechanics of toileting (6c); urinary incontinence (6d); fecal incontinence (6e) |
| 7a | Speech limited to about six intelligible words in an average day |
| 7b | Speech limited to a single intelligible word in an average day |
| 7c | Can no longer walk without personal assistance |
| 7d | Can no longer sit up without assistance |
| 7e | Can no longer smile |
| 7f | Can no longer hold up the head |
Reisberg B. Functional Assessment Staging (FAST). Psychopharmacology Bulletin 1988;24:653-659.
What FAST stage qualifies for hospice?
Stage 7 or beyond, with all of its functional findings (unable to walk, dress or bathe without help, urinary and fecal incontinence, speech of six words or fewer), plus at least one complicating condition in the past 12 months. The dementia criteria list the complications and the substages.
FAST was validated in Alzheimer's disease and expects the stages in order; the LCD section is specific to Alzheimer's disease and related disorders. In vascular, Lewy body and mixed dementias patients often skip stages, so the record should say why the prognosis is six months or less rather than rest on the stage.
Related guides
All four eligibility scales, the dementia criteria, the eligibility guidelines by diagnosis and how to refer.
Common questions
What FAST stage qualifies for hospice?
Stage 7 or beyond with all of its functional findings, plus at least one complicating condition in the past 12 months, such as aspiration pneumonia, a urinary tract infection of the kidney, septicemia, multiple stage 3 or 4 pressure ulcers, recurrent fever after antibiotics, or weight loss of 10% in six months.
Can someone below FAST 7 qualify?
Sometimes. A patient at FAST 6 with heart failure, recurrent pneumonia and steady weight loss can have a six-month prognosis. The record must say why.
About this page
- Written by
- Beta Hospice care team
- Medically reviewed by
- Oscar Chien, MD, Medical Director
- Last reviewed
- October 26, 2026
- Next review
- April 26, 2027
How we write and review this site
Sources
- CMS Medicare Coverage Database: LCD L33393, Hospice: Determining terminal status (opens in a new tab)
- Reisberg B. Functional Assessment Staging (FAST). Psychopharmacology Bulletin, 1988 (opens in a new tab)
These sources support the general information on this page. For one person鈥檚 care and coverage, talk with the hospice team.
Refer a patient or ask a clinical question
Call any time. A nurse can talk through eligibility, timing and logistics for your patient.
Patients have the right to choose their hospice provider.