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How to Know it May be Time for Hospice

Watching someone you love suffer from Alzheimer’s or another memory debilitating illness is incredibly difficult, and it can be even more challenging to decide when it’s time to consider hospice care. Here, we are sharing five signs it may be the right time to consider the extra support of hospice care for an Alzheimer’s patient.

Physician determines they are at or beyond stage 7 of the Functional Assessment Staging Scale

The Functional Assessment Staging (FAST) Scale is a tool used to determine if changes in a patient’s condition are related to Alzheimer’s disease or another condition. If due to Alzheimer’s, the changes will occur in sequential order. Alzheimer’s disease-related changes do not skip FAST stages.  

Unable to ambulate independently

This means a person is no longer able to get around on their own. For example, they require assistance getting from room to room.

Requires assistance to dress or bathe

Without assistance, you may notice they put their shoes on the wrong feet or their day-time ‘street’ clothes on over their pajamas. They are also unable to bathe without assistance.

Becomes incontinent

This includes urinary or fecal incontinence or both.

Unable to speak or communicate 

This may begin as the patient only saying 5-6 words per day and gradually reduce to only speaking one word clearly until they can no longer speak or communicate at all. This will also include the inability to smile.

Why Choose Hospice

Hospice care is for patients with a life limiting illness and a life expectancy of six months or less. The main focus is to manage pain and symptoms and ultimately keep the patient comfortable. When you choose hospice for your loved one, their care team can help you to understand what to expect in the final stages of Alzheimer’s. They will also provide support to you and the rest of your family throughout the end-of-life process.

If you would like more information on hospice care for Alzheimer’s patients, please contact us. We are here to answer any questions you may have.

Video: Tips to Improve Communication with Alzheimer’s Patients


Changes in Communication

As Alzheimer’s and Brain Awareness Month continues, we want to discuss a very important topic- communication and Alzheimer’s. As the disease progresses, a person’s ability to communicate gradually diminishes. Changes in communication vary from person to person, but there are several common issues you can expect to see, including difficulty finding the right words and organizing words logically.  

Effective Communication

If someone you love is living with the disease, you know it can be challenging at times to communicate with them. The video above discusses the following ten tips for effectively communicating with your loved one.  

Help Make Communication Easier

In addition to these tips, there are steps you can take to help make communication easier, including: You also want to encourage the person to communicate with you. You can do this by doing things like holding their hand while you talk and showing a warm, loving manner. It is also important to be patient with angry outbursts and remember that it is just the illness talking.  

If The Person is Aware of Memory Loss

Since the disease is being diagnosed at earlier stages, many people are aware of how it is impacting their memory. This can make communication even more sensitive because they may become frustrated when they are aware of the memory loss. Here are some tips for how to help someone who knows they have memory problems.  

Additional Resources

For more information on Alzheimer’s disease and how it impacts communication, visit the links or reach out to the contacts below:   ** NIA Alzheimer’s and Related Dementias Education and Referral (ADEAR) Center 800-438-4380 (toll-free) adear@nia.nih.gov   ** Family Caregiver Alliance 800-445-8106 (toll-free) info@caregiver.org   ** Alzheimer’s Association

Dear Caregiver,

If you are caring for a loved one who is living with Alzheimer’s disease, you do not need us to tell you that it’s not easy. This progressive disease is difficult to cope with – for both the person living with it and their loved ones. People living with Alzheimer’s may become frustrated when they find themselves struggling to do things they used to do without any problem. And it is hard for you, as the caregiver, to watch the person they once were gradually fade away. They may have brief moments of clarity where it feels like they are themselves again; only to break your heart when the moment is gone. While there is nothing anyone can do or say to “fix” what you and your loved one are going through, we want you to know you do not have to face it alone. The Alzheimer’s Association has an abundance of resources for both those living with Alzheimer’s and their caregivers. There are support and educational programs available for both, as well. Take advantage of these resources. They are there to help make things a little easier.  

Understanding Alzheimer’s Disease

It all starts with gaining a better understanding of the disease and how it progresses. Alzheimer’s leads to nerve cell death and tissue loss throughout the brain. This results in the brain shrinking dramatically over time which impacts nearly all its functions. Although scientists are not completely certain what causes cell death and tissue loss in a brain affected by Alzheimer’s, plaques and tangles appear to be the culprits. Plaques form when protein pieces called beta-amyloid clump together, and tangles destroy a vital cell transport system made up of proteins. Plaques and tangles tend to spread through the cortex in a predictable pattern as Alzheimer’s disease progresses, but the rate of progression varies greatly.  

Early Stage

In the earliest stages, plaques and tangles begin to form in brain areas involved in learning and memory, as well as thinking and planning. In this stage, a person can still function independently but may start to notice they are sometimes forgetting familiar words or where to find everyday objects. Someone in this stage may struggle to:


Middle Stage

In the middle stage, more plaques and tangles develop in the regions of the brain important for memory, thinking, and planning. This leads to the development of problems with memory or thinking that are severe enough to interfere with work or social life. In this stage, someone with Alzheimer’s may have trouble handling money, expressing themselves, and organizing their thoughts. Plaques and tangles also spread to areas involved in speaking and understanding speech and the sense of where your body is in relation to objects around you. It is in this stage that many people are first diagnosed. Symptoms vary from person to person, but may include:


Late Stage

Most of the cortex is seriously damaged by the time someone reaches the late stage of Alzheimer’s disease. By this point, the brain shrinks dramatically due to widespread cell death. Individuals often lose their ability to communicate, recognize family and loved ones, and to care for themselves in this stage. In this stage, symptoms are severe and may include:


Resources for Each Stage

The Alzheimer’s Association provides excellent resources for caregivers for each stage. Visit the links below to learn more.

Early-Stage Caregiving 

Middle-Stage Caregiving

Late-Stage Caregiving

Additional Information on Stages and Behaviors


Yours truly,

AT Home Care and Hospice

   July 2010 Researchers are now focusing on the accumulation of clumps of a protein called amyloid which occurs in the brain.  This occurs about 10 years before dementia sets in and is viewed as the best place to intervene in the disease.  New imaging agents for PET scans, spinal fluid tests and other tests can also help to predict the onset of Alzheimer’s and are becoming very important.  These protein deposits are referred to as biomarkers and can be tracked by brain scans, blood and spinal fluid tests. Three medical expert panels put together by the National Institute on Aging and the Alzheimer’s Association suggest that Alzheimer’s should be diagnosed in three stages  advanced disease, mild disease and, the new category, called preclinical disease. “These experts understand that the disease begins many years before dementia,” says Dr. Reisa Sperling of Brigham and Women’s Hospital in Boston.  Many researchers believe most Alzheimer’s drugs have failed because they were tried in people whose disease was too far advanced. Home health nurses perform an assessment of each patient at the start of  home care. The home care nurse will not only analyze the physical condition of the patient, but asses their competence in performing activities of daily living.  It is noted if the patient is confused or does not understand basic instruction, or appears impaired mentally.  These could be early signs of Alzheimer’s and follow up treatment by the primary care physician can be suggested. Health professionals are now classifying stages of Alzheimer’s as they would for many prevalent diseases such as cancer, heart disease and kidney disease which are all diagnosed on the basis of tests, even before symptoms appear.  Identifying dementia early can cut the cost of care by nearly 30% said researchers on July 11th, 2010.  Similarly, home health care is much more cost efficient than putting an Alzheimer’s patient with the beginning symptoms of the disease, in a nursing home. Treatments for patients with a disposition for Alzheimer’s are expanding. Antioxidants neutralize unstable forms of oxygen called reactive oxygen species that can damage cells throughout the body.  The brain is an area of high metabolic activity, so is vulnerable to accumulating oxidative damage over a lifetime.  Higher vitamin E intake is tied to lower dementia risk, but is not proven to have an affect on Alzheimer’s.  Antioxidants like vitamins E and C and beta carotene might help stave off dementia because it is believed that their actions might interfere with the process of brain-cell degeneration.  It is recommended that one consult with their physician before taking any vitamins to understand the best dosages and how they may interact with existing medication. The consensus is that a thorough examination can identify signs of dementia that may be a precursor to Alzheimer’s.  A healthy lifestyle and preventative diet can also aide in keeping  Alzheimer’s risk low. The difference between Alzheimer’s and typical age-related changes:
Signs of Alzheimer’s Typical age-related changes
Poor judgment and decision making Making a bad decision once in a while
Inability to manage a budget Missing a monthly payment
Losing track of the date or the season Forgetting which day it is and remembering later
Difficulty having a conversation Sometimes forgetting which word to use
Misplacing things and being unable to retrace steps to find them Losing things from time to time
Recent research has found that early detection can allow for more successful treatment and prevent the serious symptoms that incapacitate the patient. Alzheimer’s disease is a progressive and fatal brain disease. As many as 5.3 million Americans are living with Alzheimer’s disease. Alzheimer’s destroys brain cells, causing memory loss and problems with thinking and behavior severe enough to affect work, lifelong hobbies or social life.  Today, it is the seventh-leading cause of death in the United States and no known cure for the disease, but there is now good news revolving around early diagnosis. Recognizing the onset of Alzheimer’s is key. Older persons should speak with their primary care doctor about any signs of Alzheimer’s that they may be experiencing.  Home health care professionals are a good source for observing patients in their natural surroundings when the most common warning signs are most evident.  Care givers can take note of any of these signs and report them to the attending physician or family.

Ten Warning Signs of Alzheimer’s:

  1. Memory LossOne of the most common signs of Alzheimer’s is memory loss, especially forgetting recently learned information. Others include forgetting important dates or events; asking for the same information over and over or relying on memory aides (e.g., reminder notes or electronic devices).
  2. Challenges in Planning or Solving ProblemsSome people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before.
  3. Difficulty completing familiar tasksPeople with Alzheimer’s often find it hard to complete daily tasks. Sometimes, people may have trouble driving to a familiar location, managing a budget or remembering the rules of a favorite game.
  4. Confusion with Time or PlaceLosing track of dates, seasons and the passage of time can be common with Alzheimer’s patients. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there.
  5. Trouble understanding Visual Images and Spatial RelationshipsFor some people, having vision problems is a sign of Alzheimer’s. They may have difficulty reading, judging distance and determining color or contrast. In terms of perception, they may pass a mirror and think someone else is in the room.
  6. Problems in Speaking or WritingPeople with Alzheimer’s may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves.
  7. Misplacing ThingsA person with Alzheimer’s disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time.
  8. Decreased or Poor JudgementPeople with Alzheimer’s may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean.
  9. Withdrawl from Work or Social ActivitiesA person with Alzheimer’s may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby.
  10. Changes in Mood or PersonalityThe mood and personalities of people with Alzheimer’s can change. They can become confused, suspicious, depressed, fearful or anxious
Alzheimer’s disease is the most common type of dementia, and it affects a variety of behavioral and intellectual abilities. Since the disease is progressive, symptoms can be slower to develop, but eventually worsen with time. Early symptoms typically involve a decline in memory and struggle with thinking abilities. Later symptoms include the inability to focus on daily activities or actively participate in conversations. Disorientation, mood changes, decreased judgment, and confusion as well as apprehension around loved ones are some other common symptoms. While there is no cure for Alzheimer’s, there are various treatments available. These methods help patients manage the progressive symptoms of the disease, and allow them to function at a higher level for a longer period of time. Alzheimer’s therapy is one treatment method that helps patients deal with day to day symptoms, and face each new challenge as it emerges. Medications also work well to treat memory loss, behavioral changes and sleep disorders.

Home Treatment Plans

AT Home Care’s team of home health aides, nurses and therapists are a great resource for in-home care and support. As opposed to observing an Alzheimer’s patient in a medical environment, our in-home care team is able to observe each patient in their natural surroundings to determine the best course of action in treatment for their stage of Alzheimer’s. Then, together with the patients family we create a comprehensive in-home care plan that focuses on a high quality of life and symptom management. Alzheimer’s Statistics: Contact Us

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