A patient with dementia must have a F.A.S.T. score of seven (7) to qualify for hospice care.
FAST is an acronym for the Reisberg Functional Assessment STaging Scale. A scale nicknamed FAST to determine dementia’s severity is blatantly ironic. As a loved one’s dementia (Alzheimer’s, Lewy Bodies, etc.) worsens, he or she typically becomes, well, slower.
Currently the Reisberg scale (example found here) contains various stages and sub-categories, including these two:
- Stage 3: Decreased job functioning evident to coworkers; difficulty in traveling to new locations
- Stage 4: Decreased ability to perform complex tasks (e.g., planning dinner for guests, handling finances)
Those who have cared for someone with dementia usually sense the “slowing down” of a loved one only after he or she has worsened.
Who among us hasn’t experienced Stage #3’s “difficulty in traveling to new locations?” I recall driving to San Francisco for the first time in years and getting lost. I studied my Google Map directions and the worn-out AAA street map hiding in my glovebox and couldn’t figure out where I was! Had I “slowed down and entered Stage #3?
Whenever nearing April 15, my anxiety increases and my financial acuity decreases. Yikes, tax day! Who hasn’t complained—young, old, fast or slow—about the complexity of taxes? If my frustration about handling finances has a dramatic uptick, should I blame Stage #4 or a calendar date? It’s easy to rationalize or joke about the slow or sluggish days.
FAST’s Stage 7, with its six different sub-stages, is—quite literally—no laughing matter:
- 7a: Ability to speak limited (1 to 5 words a day)
- 7b: All intelligible vocabulary lost
- 7c: Non-ambulatory
- 7d: Unable to sit up independently
- 7e: Unable to smile
- 7f: Unable to hold head up
When a dementia patient has any sub-stage found in the 7s, they may be deemed “hospice appropriate.” However, as with many of the ways to evaluate, label and statistically analyze diseases and disease progression, medical professionals are making educated guesses. Yes, the guesses are based on experience, research, and tools like FAST. Even so, there remains much we don’t know.
My father had dementia. The first hospice to visit him at his memory care facility determined he wasn’t eligible. In part this was because he spoke 5 or more words. Thus, he wasn’t at 7a. And many of those words, while limited, seemed intelligible. Thus, he wasn’t at 7b. Except the nurse examining him hadn’t lived with him, and she had no way to grasp how much of his daily (and even worse, nightly) “speech” was rooted less in reality and more in his delusions.
For one hospice, his FAST wasn’t “slow” enough! A second hospice evaluated my father—who no longer smiled (7e), but could hold up his head (7f)—and made a guess about his disease. That hospice said the guy who taught me how to play baseball, and who told stories about meeting Hollywood stars as a kid when his father built houses in Los Angeles, had six months or less to live.
Dad died a handful of months after the first hospice said he hadn’t yet reached Stage 7.
We fool ourselves if we think medicine and science will solve everything or predict a predictable future. Even with a more precise Reisberg scale (or better or newer methods), we’ll still be a long way from solutions.
However accurate FAST becomes, I believe it’s more important to slow down and make sure you spend time right now with those you love.
(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)by