When Is Someone With Dementia Eligible for Hospice?

Families caring for someone with dementia often wait too long to ask about hospice, partly because the rules seem confusing and the disease is so unpredictable. The good news is that the rules are more flexible than many people think. Here is how Medicare actually decides, and what the dementia-specific guidelines say.

What is the basic rule for hospice?

Medicare covers hospice care when two things are true. First, the hospice doctor, and the person’s regular doctor if they have one, certify that the person is terminally ill, meaning they’re expected to live six months or less if the illness runs its normal course. Second, the person (or their representative) accepts comfort care instead of care meant to cure the illness, and signs a statement choosing hospice.

Only a doctor can certify. And the choice isn’t permanent: Medicare’s booklet says the person has the right to change their mind and stop hospice. If they live longer than six months, they can keep receiving hospice as long as a hospice doctor recertifies that they still meet the standard at the start of each benefit period after the first 90 days.

Is the six-month rule a hard deadline?

No, and this matters a great deal for dementia. CMS’s own policy manual states that the certification rests on the clinical judgment of the doctors about the normal course of the person’s illness, and acknowledges that predicting life expectancy is not always exact. Dementia is especially hard to predict. The National Institute on Aging describes its progression as often unpredictable, and the Alzheimer’s Association notes that the late stage can last from several weeks to several years. See our guide on how dementia ends.

What do the dementia guidelines say?

Medicare contractors publish guidelines to help hospices and reviewers judge when a person is appropriate for hospice. One of them, the “Hospice: Determining Terminal Status” policy from National Government Services, the Medicare contractor that serves many states (including California, New York, and Wisconsin) and has operated as Wellpoint Federal since April 1, 2026, says a person with Alzheimer’s disease or a related disorder should show all of the following:

• Stage 7 or beyond on the Functional Assessment Staging (FAST) scale. The FAST scale charts decline in function; stage 7 is marked by speech declining to about a half-dozen intelligible words and a progressive loss of the ability to walk, sit up, smile, and hold up the head
• Unable to walk without help
• Unable to dress without help
• Unable to bathe without help
• Urinary and fecal incontinence, intermittent or constant
• No consistently meaningful verbal communication: stereotypical phrases only, or six or fewer intelligible words

And, within the past 12 months, at least one of these:

• Aspiration pneumonia
• Kidney infection (pyelonephritis)
• Septicemia (a bloodstream infection)
• Multiple stage 3 to 4 pressure ulcers
• Fever that recurs after antibiotics
• Inability to maintain enough fluid and calories, with 10% weight loss over the previous six months or a low blood albumin level

The same policy also looks at general signs of decline that apply to any illness, such as recurrent serious infections, weight loss, or progressive loss of function. If you hear a clinician say someone is “FAST 7” or “7C,” this is what they’re referring to.

Are those guidelines strict requirements?

No. The policy itself says its guidelines are meant to help providers decide when patients are appropriate for hospice, that each patient is unique, and that some patients won’t match a guideline. It explains that where it says a person “should” meet a guideline, that carries great weight on review but doesn’t mean meeting it is required. The only requirement is that the documentation supports a prognosis of six months or less if the illness runs its normal course. It also says some patients may not meet the guidelines yet still have a life expectancy of six months or less, and that coverage may be approved when documentation supports that.

Two other points from the policy are worth knowing. The Alzheimer’s-specific section isn’t meant for other types of dementia, so those are generally assessed using the policy’s broader guidelines and the doctors’ judgment. And these policies are written by regional Medicare contractors, so the exact wording can differ by where you live; ask the hospice which policy applies.

What if someone lives longer than six months?

They can stay on hospice, but only while the doctors continue to certify the prognosis. The policy acknowledges there is not a strict six-month limit on the hospice benefit. It also describes two situations. If a person improves or stabilizes enough that their prognosis is no longer six months or less, they can be considered for discharge from hospice, and they can re-enroll later if they decline. But if they stabilize and still have a reasonable expectation of continued decline, they remain eligible.

What does choosing hospice change?

It changes the goal of care from trying to cure or prolong life to focusing on comfort and quality of life, along with support for the family. The Alzheimer’s Association describes a hospice team that includes a doctor, nurse, social worker, aide, clergy, and trained volunteers, and says care can be provided at home, in a hospital, or in a residential community. Ask the hospice what is and isn’t covered, since choosing hospice means giving up Medicare coverage of treatments meant to cure the terminal illness. See our guides on Medicare and hospice coverage and what hospice is.

For how this differs at home and in memory care, see hospice for dementia at home vs. in memory care.

How do I start the conversation?

You don’t have to wait for someone else to bring it up. Ask the person’s doctor, or call a local hospice and request an evaluation. The Alzheimer’s Association suggests asking the doctor directly when the best time for hospice would be, along with questions such as whether a treatment will help, what burdens it might bring, and whether it matches what the person would have wanted. If the answer is “not yet,” that’s okay; you can ask again as things change. See our guide on when to consider hospice.

If you’re thinking about your own wishes, the best time to write them down is while you still can. Record your medical wishes in a Final Day Plan.

For the feeding tube question, see Feeding tubes and dementia.

This is general educational information, not medical advice. Hospice eligibility is decided by a person’s doctors, and coverage rules and regional policies can change; the hospice, the doctor, or 1-800-MEDICARE can address your specific situation.