Hospice stays for persons with FTD or other dementias could be harder to access through Medicare if their disease progression is classified as stable, the Washington Post reported in a recent article.

The Mar. 26 article explains the findings of a recent study that discovered that about five percent of hospice patients who have dementia are pulled from hospice when their condition appears to be stabilized. Such was the case for Jean Bishop, who was diagnosed with FTD at age 79. According to the Washington Post, Bishop was enrolled, discharged, and re-enrolled into hospice several times over a three-year period due to fluctuating changes in her condition status.

When her husband, Leonard Bishop, found her unresponsive in 2011 following a second discharge from hospice, he asked his children, “If they’re just going to discharge us again, should I even do this?” Jean died almost exactly six months after her third admission, the Post reported.

When Medicare’s hospice benefit was created in 1982, it capped the definition of terminal illness at six months to live. The current regulations aren’t working as intended for many who live with dementia, the Post article suggests. Most of the early hospice users had cancer, but that has since changed. According to this study, about half of hospice enrollees have dementia, and it can be difficult to determine when persons with dementia only have six months to live.

“What makes sense is to have a different type of program that allows for a larger prognostic window, but that would also reimburse less than hospice does,” said Claire Ankuda, a palliative care physician and researcher at Mount Sinai.

Health Services researcher and former hospice medical director Joan Teno told the Post that “we need to update the payment models, and especially hospice, to really reflect this changing disease trajectory of an aging society. What I’d rather see is some flexibility.”

Read the full Washington Post article here.