Questions people ask
When should you call hospice for dementia?
You can call at any time to ask. Calling a hospice does not start anything, and no one needs permission to ask. A doctor decides when a person with dementia is eligible, using Medicare's guidance about late-stage function and recent complications. Signs that it is time to ask include weight loss, repeated infections or hospital stays, trouble swallowing, sleeping most of the day, and no longer walking.
Reviewed by our medical director, October 12, 2026
On this page (6 sections)
Anyone can call. A doctor certifies.
There is no wrong time to call a hospice with a question about dementia. A nurse can listen to what you are seeing and tell you what the next step would be. Often that step is a conversation with the person's doctor.
Hospice is for people with a serious illness when a doctor certifies that life expectancy is six months or less if the illness runs its usual course. Our medical director and your doctor make that determination. A website cannot.
With dementia, that determination rests on how the person is functioning and what has happened in the past year, not on the date of the diagnosis or on the calendar.
Signs it is time to call
Look back over the past three to six months. These changes are reasons to call a hospice or talk with the doctor. They are not a verdict.
- Weight loss, eating much less, or refusing most meals
- Repeated infections, such as pneumonia or urinary tract infections, or repeated hospital or emergency room visits
- Coughing or choking with food or drink, or holding food in the mouth
- Sleeping most of the day
- No longer walking without help, or spending the day in bed
- Speech down to a few words
- Needing help with all daily care: bathing, dressing, eating and using the toilet
What Medicare's dementia guidance looks for
Hospice claims in California are reviewed under a Medicare coverage policy called a local coverage determination, LCD L33393, Hospice: Determining Terminal Status. For Alzheimer's disease and related dementias it describes two things together.
The first is stage 7 on the Functional Assessment Staging scale, called FAST. In plain words: the person needs help with all daily care, speech is limited to about six words or fewer, and the person no longer walks without help.
The second is a serious complication in the past 12 months. The guidance lists aspiration pneumonia, a kidney infection or other upper urinary tract infection, sepsis, pressure ulcers at stage 3 or 4, fever that keeps coming back after antibiotics, or not being able to keep up nutrition, shown by losing 10 percent of body weight in six months or by a low albumin level on a blood test.
Families should not try to score this themselves. The guidance is written for doctors. It is a guide, not a test, and a person who does not fit every line can still be eligible when the doctor explains why. The doctor and the hospice medical director make that call, not a checklist.
The guidance in plain words
| What the guidance describes | What it often looks like at home |
|---|---|
| FAST stage 7: needs help with all daily care | Someone else bathes, dresses and feeds the person and helps with the toilet |
| Speech limited to about six words or fewer | A few words, a name or a yes, or no speech at all |
| No longer walks without help | Needs a person or a lift to move, or stays in bed or a chair all day |
| A serious complication in the past 12 months | A hospital stay for pneumonia, a kidney infection or sepsis, a deep pressure sore, fevers that keep returning, or steady weight loss |
Bring this page to the doctor if it helps the conversation. The doctor decides, not the table.
Related questions
Is it too early to call if she still walks?
No. Calling is a question, not a commitment. If it is not time yet, the nurse can tell you what to watch for and whether palliative care might help now. See hospice and palliative care compared.
What if the doctor says it is not time yet?
Ask what would change the answer, and ask to be told when it does. You can also ask the hospice to speak with the doctor directly. Dementia changes slowly, and a second look a few months later is common.
Can hospice start in a memory care community or a nursing facility?
Yes. Hospice comes to wherever the person lives and works alongside the facility staff. Medicare does not pay room and board where you live. See where care happens.
Who pays for hospice for dementia?
Medicare covers hospice care related to the terminal illness. Under Medicare, most people pay nothing for hospice care itself. Medi-Cal covers hospice, and most private plans include a hospice benefit. See paying for care.
Read more
The fuller pages: hospice care for dementia, is it time for hospice and, for clinicians, the dementia eligibility guide.
About this page
- Written by
- Beta Hospice care team
- Clinically reviewed by
- our medical director
- Last reviewed
- October 12, 2026
- Next review
- April 12, 2027
How we write and review this site
Sources
- CMS Medicare Coverage Database: LCD L33393, Hospice: Determining Terminal Status (opens in a new tab)
- National Institute on Aging: Alzheimer's disease and dementia (opens in a new tab)
- Medicare.gov: Hospice care coverage (opens in a new tab)
These sources support the general information on this page. For one personās care and coverage, talk with the hospice team.
You do not have to decide alone.
Call (844) 646-4434 any time, or leave your number and someone from Beta's hospice team will call you. No decision is needed to call. Most families start with a question.
Only a hospice doctor, together with the personās own doctor, can confirm hospice eligibility. A website cannot.
- A nurse answers 24 hours a day, 7 days a week
- You can stop hospice at any time
- You have the right to choose your hospice