Dementia pts and hospice


I recently started working for hospice, my background is Med-Surg and home health. I am having a hard time understanding the criteria per CMS guidelines for a dementia pt. My current employer has educated me that the pt has to be a 7A on the fast scale (something I am still trying to learn) any tips, advice or references would be helpful. I don't want to admit pts who are not appropriate.

thanks :)

Kittypower123, BSN, RN

Specializes in Hospice. Has 6 years experience.

Hopefully you have a copy of the FAST with you for reference. It's important to remember that you cannot skip an item. Start at number one and continue until something doesn't apply to the patient. Numbers 1 through 5 are one item each. Once you 6, there are multiple items. 6 is divided into 6a through 6e and 7 into 7a through 7b.

6d is incontinent of bladder and 6e is incontinent of bowel. If the patient is continent of bowel, but not bladder, they would be a 6d. You have to stop there even if some of the 7 items apply.

7a is no more than 5 intelligible words per day. The words do not have to be appropriate to the context. For example, you may ask "How are you?" And the patient answers "brother." It's a word and counts.

Keep in mind that this scale was designed for Alzheimer's patients and does not work well with other types of dementia. A person with vascular dementia may rate differently from one day to the next. Also a person with another type of dementia may still be hospice appropriate and not be a 7a. The doctor has the final say on whether the patient is appropriate. Good documentation of all the diseases and conditions the patient has and recent decline is important in these cases.

Your coworkers, supervisors and hospice doctors will be good resources while you are learning and whenever you have questions. Don't be afraid to ask for help. Wishing you the best!


Has 43 years experience.

Yes...the part about Alzheimers vs. other dementias is important.

For those nonAlzheimers dementia patients you will likely have to provide documentation of other health issues to facilitate the SOC. If the dementia patient does not meet the specific dementia criteria you must admit using another dx.