Functional Assessment Staging Tool (For Alzheimer’s Disease)

Call or email the Hospice Team for the most accurate assessment of the patient’s eligibility.

Ph:
E:

Stage Assessment (Score is highest consecutive level of disability)

1. No difficulties, either subjectively or objectively

2. Complains of forgetting location of objects; subjective word finding difficulties

3. Decreased job functioning evident to coworkers; difficulty traveling to new locations

4. Decreased ability to perform complex tasks (e.g., planning dinner for guests; handling finances; marketing).

5. Requires assistance choosing proper clothing for season or occasion.

6a. Difficulty putting clothing on properly without assistance

6b. Unable to bathe properly; may develop fear of bathing. Will usually require assistance adjusting bath water temperature.

6c. Inability to handle mechanics of toileting (i.e., forgets to flush; doesn’t wipe properly).

6d. Urinary incontinence, occasional or more frequent over last two weeks.

6e. Fecal incontinence, occasional or more frequent over last two weeks.

7a. Ability to speak limited to about half a dozen words in an average day

7b. Intelligible vocabulary limited to a single word in an average day.

7c. Nonambulatory (unable to walk without assistance).

7d. Unable to sit up independently.

7e. Unable to smile.

7f. Unable to hold head up.