Question about the FAST scale

Specialties Hospice

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I've been struggling a bit with my company's interpretation of the FAST scale for dementia. As you all know, a patient must be at least a 7A to qualify for a hospice dementia diagnosis. 7A describes as follows: Person speaks 5-6 intelligible words in the course of a day or an intensive interview.

I interpret most things quite literally and the word "intelligible" literally means the word is understood by the listener. I have a NH patient who is quite verbal and easily understood, but she makes little sense. She is oriented x 1, repeats herself frequently, will readily tell you "I'm hungry", "They haven't fed me and they better not bill me for it either" (not true btw- she eats all the time) and will answer questions about her family to some extent. Memory is very poor- she calls out frequently for her deceased husband as though he were in the next room when in actuality, she attended his funeral 2-3 yrs ago. REAL conversation is limited but I have trouble classifying her as a 7A. What do you all think?

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Specializes in Psychiatry, geriatrics, hospice.
I've been struggling a bit with my company's interpretation of the FAST scale for dementia. As you all know, a patient must be at least a 7A to qualify for a hospice dementia diagnosis. 7A describes as follows: Person speaks 5-6 intelligible words in the course of a day or an intensive interview.

I interpret most things quite literally and the word "intelligible" literally means the word is understood by the listener. I have a NH patient who is quite verbal and easily understood, but she makes little sense. She is oriented x 1, repeats herself frequently, will readily tell you "I'm hungry", "They haven't fed me and they better not bill me for it either" (not true btw- she eats all the time) and will answer questions about her family to some extent. Memory is very poor- she calls out frequently for her deceased husband as though he were in the next room when in actuality, she attended his funeral 2-3 yrs ago. REAL conversation is limited but I have trouble classifying her as a 7A. What do you all think?

That does make it hard but also remember just because they can say their name doesn't mean they are oriented x 1. That is a conditioned response they have answered all their lives.

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

What about the other elements of the FAST scale?

Is she ambulatory? Continent?

What is her PPS?

The team should collaborate to place her in the proper diagnosis category, perhaps she better meets a debility dx.

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Specializes in LTC, Sub-Acute, Hopsice.

I have been taught that the "5-6 words" means just that. 5 or 6 different words. They don't have to make a sentence, don't have to be connected to each other in any way, just able to be understood as words. If this patient meets all of the criteria up to 7A, but speaks as much as you say, she is not a 7A, she is a 6(whatever, I don't have a FAST in front of me, and I seem to have a bit of short term memory loss after working 7 days straight!). Also, if you read the fine print on a FAST scale, it is supposed to be applied to Alzheimers patients, and does not adequately measure other forms of dementia (Lewey Body for example, or vascular dementia)

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

Exactly, Alzheimer's patients will often lose ambulatory function before many of the other dementias do. Others maintain a verbal skill set that exceeds all other cognitive and functional abilities.

The dementias, in general, are a very interesting but terribly devastating disease group.

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For fast scale 7c does this mean absolutely no ambulation or can an individual walk with assist say a walker or of 2 person help

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Specializes in Hospice, Geriatrics, Wounds.

FAST scale scoring MUST BE SEQUENTIALLY (its not the lowest score for which the pt qualifies, its the lowest CONSECUTIVE score) They shouldn't be able to ambulate without personal assistance (someone holding them up so they can walk...its not walker, cane, SBA).

So, if your pt is making a sentence, she would at least score 6e. (Speech limited to approx 6 intelligible words in a day or interview=7a) . Just because a pt cant walk/smile/sit up, etc but does talk/communicate...you cant skip 7a/7b.... intelligible words are words...non-intelligible words are just jumbled sounds. Even if the sentence she makes has no meaning or not true doesnt mean she doesnt have "intelligible vocabulary". She may say they dont feed her (when she just ate), but we expect that with dementia bc their short term memory is affected. So, in my opinion, she doesn't meet medicares criteria.....

A pt has to be at stage 7a to qualify for hospice services.

This is the understanding Ive always had when using the FAST scale....

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NHPCO guidelines state that a FAST stage 7A is appropriate for hospice enrollment, if the patient also exhibits one or more specific dementia-related co-morbidities (aspiration, upper urinary tract infection, sepsis, multiple stage 3-4 ulcers, persistent fever, weight loss >10% within six months). But this is not a CMS requirement and the MD can make the decision based on other factors. My understanding is that there is very little evidentiary support for use of the FAST scale as a hospice eligibility tool.

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