CDP End-of-Life Care Planning 2 — Questions and Answers
Question 1: A person with late-stage dementia is admitted to hospice. Which hospice eligibility criterion specifically applies to dementia patients in the US?
- FAST scale stage 7C or beyond with one or more complications (Correct answer)
- MMSE score below 10 with behavioral symptoms
- CDR scale score of 2 or higher with weight loss
- GDS stage 5 with documented functional decline
Correct answer: FAST scale stage 7C or beyond with one or more complications
Medicare hospice eligibility for dementia uses the FAST scale, requiring stage 7C (inability to speak more than 6 words) plus at least one complication such as aspiration pneumonia, septicemia, or pressure ulcers.
Question 2: During a care conference, a family requests aggressive interventions despite the person with dementia having previously completed a DNR order. What is the most appropriate response?
- Override the DNR based on family wishes
- Educate the family about the legally binding nature of the DNR and the patient's previously expressed wishes (Correct answer)
- Transfer care to another facility that will honor family wishes
- Suspend the DNR temporarily while the family processes grief
Correct answer: Educate the family about the legally binding nature of the DNR and the patient's previously expressed wishes
A valid DNR reflects the patient's autonomous decision-making and is legally binding; the care team should compassionately educate the family while honoring the documented wishes.
Question 3: Which ethical principle is MOST central to honoring an advance directive completed before dementia onset?
- Beneficence
- Non-maleficence
- Autonomy (Correct answer)
- Justice
Correct answer: Autonomy
Autonomy—the right of individuals to make decisions about their own care—is the foundational principle behind advance directives, allowing prior competent wishes to guide future care.
Question 4: A dementia practitioner notices a resident with late-stage dementia grimacing during repositioning. The best action using a comfort-focused care model is to:
- Limit repositioning to prevent further distress
- Administer a scheduled analgesic and document pain response (Correct answer)
- Report to the physician and await orders before repositioning again
- Apply ice packs and monitor for improvement
Correct answer: Administer a scheduled analgesic and document pain response
In comfort-focused care, pain management is proactive; administering scheduled analgesics and documenting behavioral pain indicators ensures ongoing comfort and informs the care plan.
Question 5: Which tool is specifically validated for assessing pain in non-verbal individuals with advanced dementia?
- Wong-Baker FACES Scale
- Numeric Rating Scale (NRS)
- PAINAD (Pain Assessment in Advanced Dementia) (Correct answer)
- Visual Analog Scale (VAS)
Correct answer: PAINAD (Pain Assessment in Advanced Dementia)
The PAINAD scale uses observable behavioral indicators such as breathing, vocalizations, facial expression, body language, and consolability to quantify pain in non-verbal dementia patients.
Question 6: A family member insists on inserting a PEG tube for a person with advanced dementia who is refusing to eat. Evidence-based guidance recommends:
- Proceeding with PEG insertion to prevent malnutrition
- Offering careful hand feeding, which preserves comfort and does not worsen outcomes (Correct answer)
- Initiating IV nutrition as a compromise
- Deferring entirely to family wishes as surrogate decision-makers
Correct answer: Offering careful hand feeding, which preserves comfort and does not worsen outcomes
Research consistently shows that tube feeding in advanced dementia does not improve survival, comfort, or quality of life, and careful hand feeding is the evidence-based, comfort-focused alternative.
Question 7: Which document specifically designates a trusted person to make healthcare decisions when an individual lacks decision-making capacity?
- Living will
- Do-Not-Resuscitate order
- Durable Power of Attorney for Healthcare (Correct answer)
- POLST form
Correct answer: Durable Power of Attorney for Healthcare
A Durable Power of Attorney for Healthcare (Healthcare Proxy) legally designates a surrogate to make medical decisions on behalf of someone who has lost decision-making capacity.
CDP End-of-Life Care Planning 2
A person with late-stage dementia is admitted to hospice.
Which hospice eligibility criterion specifically applies to dementia patients in the US?