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In Reply: In response to Dr Cherney, an estimated life expectancy of less than 6 months is the main eligibility criterion for hospice. In 1996, the National Hospice Organization (now known as the National Hospice and Palliative Care Organization) developed guidelines to estimate the prognosis for noncancer diagnoses for the purposes of determining hospice eligibility.¹ In these guidelines, the FAST scale² was included as a component of the eligibility criteria for patients with a primary diagnosis of dementia. Individual hospice providers may interpret these guidelines differently. However, the original National Hospice Organization guidelines,¹ most recent Centers for Medicare & Medicaid Services coverage guidelines,³ current interpretation by major hospice providers,^4-5 and a recent review article⁶ indicate that for patients with dementia to qualify for hospice they must be at or beyond FAST stage 7 and be unable to ambulate independently. This effectively makes the cut-off stage 7c on the FAST scale.²

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Susan L. Mitchell, MD, MPH
smitchell@hrca.harvard.edu
Hebrew SeniorLife
Boston, Massachusetts

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