Hospice Care for Dementia and Alzheimer’s in Metro Detroit

Updated October 2026. Written and reviewed by the Lily Hospice clinical team.

Yes, advanced dementia or Alzheimer’s qualifies for hospice in Michigan once a physician judges that life expectancy is likely six months or less. Medicare, Michigan Medicaid and most private plans cover it in full, at home or in memory care. Lily Hospice evaluates the same day across Oakland, Macomb and Wayne counties.

In Medicare’s most recent Care Compare data, 71.3% of Lily Hospice patients were visited by a nurse or social worker in their last three days of life, against a national average of 48.3% and a metro Detroit median of 60.9% across the 104 hospices serving Oakland, Macomb and Wayne counties. “Most families tell us afterward that they wish they had called sooner,” says the Lily Hospice clinical team. “The evaluation is free, and the earlier we meet a family, the more good days we can protect.”

Dementia does not end the way most families expect. There is rarely one dramatic moment. Instead there is a slow narrowing: fewer words, then fewer steps, then meals that take an hour and still end with most of the plate untouched. Families in Troy, Sterling Heights and Livonia tell us the hardest part is not knowing whether what they are seeing is “just the disease” or a sign that it is time for more help.

Hospice was built for exactly this stretch. It does not stop dementia, and it does not replace the memory care staff or the daughter who has been doing everything. It adds a nurse who knows what late-stage Alzheimer’s looks like, an aide for bathing and skin care, a social worker for the paperwork and the family conversations, and one phone number that a real person answers at 3 a.m.

How Lily Hospice cares for people with dementia

Dementia is a large part of what we do. In Medicare’s most recent Care Compare data (2024), about one in five Lily patients had dementia as their primary diagnosis, and nearly half of our care took place in assisted living and memory care communities. This is what that experience looks like in practice:

• Dementia-trained nurses and aides. Our team is trained in dementia care: reading pain and distress in someone who cannot describe it, approaching care calmly, and keeping routines familiar.
• Coaching for the family and the facility staff. We teach caregivers what to do about sundowning and evening agitation, refusing food or medication, resisting baths, and the fear that can come with personal care, so everyday moments are less of a struggle.
• Music, sensory comfort and the Journey Program. Familiar music and gentle sensory activities can reach people when words no longer do, and our Journey Program, featured on FOX 2 Detroit, uses virtual reality to bring calm, familiar places to patients who can no longer travel.
• Regular visits inside memory care and assisted living. We work alongside community staff in Oakland, Macomb and Wayne counties, add hospice nursing, aide, social work and chaplain visits, and give the staff a hospice nurse to call around the clock.
• Care in the family’s language and with dignity. Professional interpreters join visits and calls when a family needs one, and families can ask for an aide of the same gender for personal care.
• Part of the local dementia community. Lily sponsored the 2026 Detroit Walk to End Alzheimer’s, and we point families to the Alzheimer’s Association Michigan Chapter for support that continues alongside hospice.

Dementia hospice in Michigan: how it works here

The rules are federal, but the help is local. Medicare’s hospice benefit pays any Medicare-certified hospice in Michigan the same way, and the state’s own Hospice Care in Michigan page from MDHHS explains the patient rights that come with it, including the right to choose your hospice. For someone with dementia in a nursing facility on Michigan Medicaid, Medicaid keeps paying room and board while Medicare pays the hospice; see hospice and long-term-care Medicaid in Michigan. The Alzheimer’s Association Michigan Chapter, headquartered in Southfield, runs a 24/7 helpline at 800-272-3900 that many of our families lean on alongside hospice. And because a dementia journey can be long, it helps to know that hospice in Michigan is not a six-month clock: read how long hospice lasts and what happens on the first hospice visit.

Signs it may be time to talk about hospice

Medicare uses a specific staging scale for dementia, and your loved one’s physician makes the final call. But these are the changes families usually notice first:

• Needs help with nearly every daily activity: dressing, bathing, using the toilet, walking
• Speech has shrunk to a handful of words, or is gone
• Can no longer walk without help, or is mostly in bed or a chair
• Trouble swallowing, coughing with meals, or refusing food and drink
• Weight loss over the past six months without trying
• Repeated infections in the last year: pneumonia, urinary infections, infected pressure sores
• A hospital or ER visit that did not really change anything
• A caregiver who is exhausted, frightened, or both

If several of these feel familiar, it is not too early to ask. Most families tell us later that they wish they had called sooner.

Dementia stages and hospice: the FAST scale in plain words

Doctors often describe the stage of Alzheimer’s and other dementias with the Functional Assessment Staging Tool, or FAST, which follows the order in which abilities are usually lost. Hospice conversations usually begin in the last two stages:

FAST stage	What families usually see
Stage 6 (moderately severe)	Needs help dressing, then bathing, then using the toilet; begins to lose bladder and then bowel control.
Stage 7 (severe)	Speech shrinks to a few words a day, then a single word or none; cannot walk without help, then cannot sit up without support; later loses the ability to smile or hold up the head.

The guidelines Medicare’s contractors publish for dementia commonly look for someone at stage 7 who can no longer walk, dress or bathe without help, is incontinent, and no longer speaks in a consistently meaningful way, along with at least one serious complication in the past year: aspiration pneumonia, a kidney or bloodstream infection, deep pressure sores, repeated fevers despite antibiotics, or not eating and drinking enough to maintain weight. These are guidelines, not a checklist that must be complete: a physician can certify hospice based on the whole picture. If you are not sure where your loved one is, a free hospice evaluation will tell you.

What hospice actually does for someone with dementia

Comfort instead of crisis. Late-stage dementia brings pain that cannot be described in words, agitation in the evenings, and fear during care. Our nurses are trained to read those signs and treat them, so that a bath does not become a battle and nights become calmer for everyone.

Fewer ambulance rides. Every trip to the ER is disorienting for someone with dementia and often makes the confusion worse. With hospice, most fevers, breathing changes and falls are managed where your loved one lives. A nurse comes to you, not the other way around.

Help for the people doing the caring. A hospice aide visits for personal care. Volunteers can sit with your mother so you can get to the pharmacy. Respite care gives a family caregiver a few days to sleep. After a death, bereavement support continues for your family for more than a year.

When eating stops. Late in dementia the body needs and wants less. We help families offer small amounts safely, explain what the change means, and take the pressure off mealtimes; our guide on when a dying person stops eating and drinking answers the questions that keep families up at night. If your parent with early-stage dementia still lives alone, read hospice when your parent lives alone.

Care wherever home is. Many of the families we serve have a parent in memory care in Farmington Hills, West Bloomfield, Shelby Township or Canton. Hospice works inside the community’s routine, adds to what the staff already do, and gives the facility a nurse to call at night.

Choosing the best hospice for dementia in Michigan

Every Medicare-certified hospice in Michigan is paid the same way, so the differences that matter for dementia are in how the team works. These are the questions worth asking any hospice you are considering in Southeast Michigan, with Lily’s answers:

• Is the team trained in dementia care? Nurses and aides should be able to read pain and distress in someone who cannot describe it. Lily’s nurses and aides are dementia-trained.
• How often do they visit inside memory care, and who does the staff call at night? Lily makes regular visits in memory care and assisted living and gives the community’s staff a hospice nurse to call around the clock.
• Will they coach the family and the staff? Sundowning, agitation, refusing food or a bath: Lily’s team coaches caregivers through all of them.
• Are they there near the end? Medicare publishes the share of patients a nurse or social worker visited in their last three days of life. Lily’s figure is 71.3%, against 63.3% for Michigan and 48.3% nationally (Care Compare, August 2026 release).
• How much dementia care do they actually do? In Medicare’s 2024 data, about one in five Lily patients had dementia as their primary diagnosis, and nearly half of our care took place in assisted living and memory care communities.

You can check any hospice’s Medicare measures in our free hospice finder, or see all 104 hospices serving Oakland, Macomb and Wayne counties side by side in our metro Detroit hospice directory.

A dementia hospice checklist for Michigan families

1. Ask the doctor or the memory care nurse for a hospice evaluation. You can also call a hospice directly; no referral is needed to ask.
2. Find the paperwork. The durable power of attorney for health care (the patient advocate designation in Michigan), any living will, and any Do-Not-Resuscitate order or MI-POST form already signed.
3. Write down the last six months. Weight changes, infections, hospital or ER visits, falls, and changes in eating, walking and speech. These are the details the hospice team and physician weigh.
4. Compare two or three hospices. Use our hospice finder to see which hospices serve your ZIP code and how they compare on Medicare’s quality measures, and ask each one how they care for people with dementia.
5. Ask about cost before you worry about it. Our hospice cost calculator shows what Medicare, Medicaid and Medicare Advantage cover, including memory care room and board.
6. Tell the memory care community. Hospice works best when the community knows who to call at night. The hospice coordinates with them directly.

A note on feeding tubes and hospital transfers

Families are often asked, sometimes in a hallway, whether they want a feeding tube or a transfer to the hospital. For advanced dementia the evidence is that feeding tubes rarely help and often cause harm, and that hospitalization tends to accelerate decline. We will never make that decision for you. We will sit down with you, explain what each choice usually means, and support whatever you decide.

Common questions

Is dementia by itself enough to qualify for hospice?

Yes, when the disease has reached its advanced stage. A physician certifies that life expectancy is likely six months or less if the illness follows its usual course. Advanced dementia, especially with recent weight loss, infections or swallowing problems, often meets that standard. We can do a no-obligation evaluation and tell you honestly where things stand.

My mother is in memory care. Can she stay there and still have hospice?

Yes. Hospice comes to her. We coordinate with the community’s staff, add nursing, aide, social work and chaplain visits, and give the staff a hospice nurse to call around the clock.

What if she lives longer than six months?

Then care continues. Hospice is re-certified as long as your loved one remains eligible. Some people with dementia are on hospice for a year or more; nobody is “discharged for living.”

Does hospice mean we stop all her medications?

No. We keep what adds comfort and gently review what no longer helps, always with you. Many families find the medication list gets shorter and their loved one is calmer for it.

Who pays?

The Medicare hospice benefit covers the hospice team, medications related to the illness, and equipment such as a hospital bed, with little or nothing out of pocket for most families. Medicaid and most private plans have a similar benefit.

Does Medicaid cover hospice for dementia in a Michigan nursing home?

Yes. Michigan Medicaid has a hospice benefit that mirrors Medicare’s. When someone has both, Medicare pays the hospice and Medicaid keeps paying the nursing facility’s room and board, routed through the hospice, so choosing hospice never puts the Medicaid bed at risk.

She has stopped eating. Is that the disease, or the end?

Often both. In advanced dementia the swallowing reflex weakens and appetite fades, and this is one of the signs physicians weigh for hospice eligibility. The hospice nurse shows the family how to offer food and fluids safely and explains what the change means, so nobody has to guess.

Who answers if the memory care staff call at 2 a.m.?

A real person at Lily, 24 hours a day, at (248) 955-5100. A hospice nurse calls back, gives instructions, and comes out when a visit is needed, so the community does not have to send your mother to the emergency room by default. See who answers a hospice phone at night.

What is the best hospice for dementia in Michigan and metro Detroit?

The best fit is a hospice that serves your loved one’s ZIP code, has nurses and aides trained in dementia care, visits often inside memory care, coaches the family through agitation and eating changes, and shows up near the end. Compare hospices on Medicare’s measures with our hospice finder, then ask each one how it cares for people with dementia. On Medicare’s last-days visit measure, Lily’s 71.3% compares with 63.3% for Michigan and 48.3% nationally. Lily Hospice serves Oakland, Macomb and Wayne counties and is glad to be one of the calls you make.

What stage of dementia qualifies for hospice?

Usually FAST stage 7, the most severe stage: the person needs help walking, dressing and bathing, is incontinent and speaks only a few words, and has had a serious complication such as pneumonia, a serious infection, pressure sores or weight loss in the past year. A physician makes the final judgment, and can certify based on the whole picture.

Does Lily Hospice have dementia-trained staff?

Yes. Lily’s nurses and aides are trained in dementia care, the team coaches families and memory care staff through sundowning, agitation and eating changes, and patients can take part in music, sensory comfort and the Journey Program virtual reality experience. In 2024 about one in five Lily patients had dementia as their primary diagnosis.

Related guides: hospice care for heart failure, hospice care for COPD and lung disease, hospice care for cancer, hospice care for Parkinson’s, ALS and neurological illness, hospice care after a stroke, hospice for kidney failure and stopping dialysis, hospice for end-stage liver disease, hospice for frailty and advanced age, hospice for ALS. For everything else, see 95 questions families ask about hospice and our plain-language hospice glossary.

Where we come to you

Lily Hospice cares for families at home, in assisted living, memory care and nursing facilities across Oakland County, Macomb County and Wayne County, from our office in Troy. Veterans and their families can read about our veteran-specific hospice care.

General education, not medical advice. Whether hospice is appropriate is a decision made with your loved one’s physician. Medicare hospice eligibility is based on a physician’s judgment that life expectancy is six months or less if the illness runs its usual course; people are not required to stop living past six months, and care can continue as long as they remain eligible.

Hospice isn’t giving up. It’s showing up. Call (248) 955-5100. A real person answers, 24 hours a day.

More answers for families

Which hospice can admit the same day, including weekends? · Can hospice come to assisted living or memory care? · Hospice for a veteran in metro Detroit · Which hospice is best in metro Detroit? · Is Lily a good hospice? An honest answer · All 104 metro Detroit hospices compared · Who answers a hospice phone at night? · Hospice with Medicaid only or no insurance · Can I keep my own doctor? · How to start hospice this weekend

Most of our dementia patients live in memory care; see how hospice works in assisted living and memory care.