There’s a particular kind of exhaustion that shows up in late-stage dementia. It isn’t only physical—though the lifting, the overnight wakeups, the constant vigilance can wear down even the strongest family. It’s also the exhaustion of not knowing what the next change means. Is this a “bad week” or a turning point? Is it time to call for more help? Are we supposed to be planning for hospice, or would that be “giving up”?
If you’re asking questions like these, you’re not alone. Many families reach for the FAST scale dementia framework because it offers something dementia often steals: a little structure. The Reisberg FAST scale (short for Functional Assessment Staging Tool) is commonly used to describe dementia progression by what a person can still do day to day—dressing, bathing, walking, speaking—especially in Alzheimer’s disease. It doesn’t predict an exact timeline, but it helps families and clinicians use the same language when talking about function, safety, and comfort.
This guide focuses on what families most want to understand: what FAST stage 7 often looks like at home, why FAST 7c hospice comes up so frequently in eligibility conversations, and how to think about practical next steps—care planning, paperwork, and, when you feel ready, funeral planning—without turning a tender season into a checklist you have to “complete.”
What the FAST scale measures—and what it doesn’t
The FAST scale describes dementia through functional ability. In plain language, it asks: what tasks can this person reliably do without help? That’s different from a memory test. It’s also different from the more familiar “mild, moderate, severe” descriptions you may see on the Alzheimer’s Association stages overview. Dementia affects people unevenly; someone might still recognize family but be unable to dress or use the bathroom safely, or a person may still walk while losing speech. FAST gives clinicians a way to document function consistently and notice meaningful shifts over time.
What FAST does not do is offer a precise prognosis. Two people can reach the same stage and have very different medical risks depending on swallowing ability, infections, weight loss, other chronic conditions, and the quality of daily support. That’s why hospice decisions are not based on FAST alone. Medicare’s hospice guidance is anchored in physician certification of a life expectancy of six months or less if the illness runs its expected course, and FAST is one piece of the clinical picture used to support that judgment, particularly for Alzheimer’s dementia. You can see how Medicare frames hospice terminal status guidance through the Centers for Medicare & Medicaid Services Local Coverage Determination on hospice terminal status.
Understanding Stage 7 in real life
By the time a person reaches Stage 7, families are usually providing hands-on help with nearly everything. The changes can feel heartbreakingly physical—less walking, less steady sitting, less swallowing—alongside the cognitive changes you may have been living with for years. A loved one might still have moments of connection, but those moments often arrive in fragments: a squeeze of the hand, a familiar look, a soft hum when music plays.
Clinicians often describe Stage 7 with sub-stages that mark functional losses in a general sequence. Not every person follows the same path, but these milestones can help you recognize why a care plan that worked last month may no longer fit this month.
- Stage 7a: Speech becomes limited—sentences fade into short phrases.
- Stage 7b: Speech may narrow to single words or repeated sounds.
- Stage 7c: Walking becomes impossible without personal assistance.
- Stage 7d: Sitting upright independently becomes difficult.
- Stage 7e: Smiling may disappear as facial muscles weaken.
- Stage 7f: Head control becomes limited, especially when fatigued.
Families often notice that Stage 7 changes don’t arrive one at a time. Losses can cluster: a fall leads to fear of walking; fear of walking leads to more time in bed; more time in bed leads to skin breakdown and weaker swallowing. It can also be difficult to separate dementia progression from medical setbacks—dehydration, urinary infections, constipation, medication side effects—that are treatable but can look like a sudden “drop.” In late-stage dementia, even treatable problems can hit harder because the body has fewer reserves.
Why FAST 7c matters in hospice conversations
You may hear a clinician mention FAST 7c hospice because Medicare hospice guidelines commonly reference Stage 7c as a functional threshold for advanced Alzheimer’s dementia—particularly when the person also shows earlier Stage 6 losses (needing help dressing, bathing, toileting, and having incontinence) and then develops complications that signal limited reserve. The Center to Advance Palliative Care summarizes Medicare hospice guidance for dementia with the common expectation that a person is at or beyond FAST 7c and demonstrates the features of the preceding stages.
In practice, hospice teams are not looking for perfection on a scale; they’re looking for a pattern that suggests the body is moving into a fragile phase. That pattern often includes severe functional dependence plus complications such as recurrent infections, aspiration risk, pressure injuries, and significant nutritional decline. A hospice-focused dementia prognosis guide used by Medicare contractors describes advanced dementia criteria and the kinds of complications that help support eligibility, including infections and impaired nutrition and swallowing. One example is this CGS Medicare dementia hospice prognosis reference.
If you’re wondering whether hospice is “too early,” it can help to reframe the question. Hospice isn’t a place someone goes to die; it’s a layer of support that comes to the person—often at home—to manage symptoms, reduce crisis hospitalizations, provide equipment, teach caregivers, and support the whole family emotionally. Many families later wish they had called earlier, not because it would have changed the outcome, but because it can change how hard the final months feel.
What families commonly see in late-stage dementia
Late-stage dementia can be quiet in a way that surprises people. The dramatic agitation of middle stage may soften, but new forms of distress can appear: grimacing, restlessness, vocalizations, resisting care. Pain is often under-recognized because the person can’t explain it. A good team will treat behavior as communication and ask what might be driving it—urinary discomfort, constipation, a sore tooth, a pressure spot, hunger, cold, fear, overstimulation.
Eating and swallowing changes
Swallowing changes are among the most emotionally difficult milestones. Families may see coughing during meals, pocketing food in the cheeks, fatigue that makes chewing impossible, or a sudden preference for soft foods. These changes raise the risk of aspiration (food or liquid going into the airway), which can lead to pneumonia. In advanced dementia, the goal often shifts from “meeting nutrition targets” to “reducing distress and honoring comfort.” Hospice teams can help with strategies such as modified textures, smaller bites, slower pacing, upright positioning, and attentive mouth care—along with honest conversations about what feeding can and can’t accomplish in end-stage disease.
Mobility and skin integrity
As walking and sitting decline, pressure injuries become a real concern. This isn’t a reflection of poor caregiving; it’s a reality of fragile skin, limited movement, and reduced nutrition. Support surfaces, turning schedules that respect sleep and comfort, gentle hygiene, and prompt attention to redness can make a meaningful difference. Hospice equipment—hospital beds, pressure-relieving mattresses, mobility aids—can reduce caregiver strain and improve the person’s comfort.
Sleep, breathing, and frequent infections
Families often report more sleeping, less daytime engagement, and a narrowing of the person’s world to a few minutes at a time. Infections can recur—urinary infections, pneumonia, skin infections—sometimes without a fever. The question many caregivers face is not “Can we treat this?” but “Does treatment align with what we want this phase to be?” A hospice team can help you weigh antibiotics, hospital transfers, and testing against comfort, disorientation risk, and the person’s likely ability to recover.
When to ask for a hospice evaluation
If you’re seeing Stage 7-level dependence and any pattern of decline—weight loss, repeated infections, increasing time in bed, swallowing changes, recurring pressure injuries—it is reasonable to ask for a hospice evaluation. An evaluation doesn’t obligate you to enroll. It simply gives you information and a plan.
Many families find it helpful to bring one practical sentence to the clinician: “We’re noticing bigger changes, and we want to understand whether comfort-focused care would support them better now.” That language keeps the conversation grounded. It also avoids the common fear that hospice is a single, dramatic decision. In reality, it’s a medical service designed to reduce suffering.
Planning ahead without losing the present
When dementia reaches late stage, planning can feel like a betrayal—like you’re “moving on” before the person is gone. But gentle planning is often an act of protection. It protects the caregiver from crisis decision-making. It protects family relationships from conflict. And it protects the person with dementia from aggressive care that may not match what they would have wanted.
That planning might include reviewing advance directives, talking through hospitalization preferences, and deciding who will be the point person for updates. It can also include beginning funeral planning in a quiet, low-pressure way. Some families do this before death because it reduces panic later; other families prefer to wait. There isn’t a morally “right” timing—only what helps your family stay steady.
Why more families are choosing cremation—and what that means for memorial choices
Part of funeral planning today is simply understanding the options that are becoming more common. According to the National Funeral Directors Association, the U.S. cremation rate is projected to be 63.4% in 2025, compared with a projected burial rate of 31.6%, with cremation projected to grow further over the coming decades. The Cremation Association of North America reports a U.S. cremation rate of 61.8% in 2024 and provides projections for continued growth in the years ahead.
What this means in a family’s living room is simpler than it sounds: more people are navigating questions about urns, keepsakes, scattering, and home memorials—often while grieving and sleep-deprived. If cremation is part of your plan (now or later), it can help to know that you don’t have to decide everything at once. Cremation doesn’t remove the need for ceremony; it just changes the timeline and the objects you may use to honor the person.
Urns and keepsakes as part of a dementia goodbye
Dementia loss can feel like a long farewell. When death finally comes, families often want a memorial that feels simple, clear, and personal—something that gathers the years of caregiving into one meaningful place to put love. For cremation, that often begins with choosing cremation urns that match the plan: an urn for home, a niche at a cemetery, a burial, or scattering later.
If you want a gentle starting place, Funeral.com’s cremation urns for ashes collection brings together a wide range of materials and styles, and the Journal guide Choosing a Cremation Urn can help you translate “capacity” and “closure” into a real-world decision.
Many dementia families also choose to share ashes among adult children or siblings. That’s where keepsake urns and small cremation urns can reduce conflict and make room for more than one kind of grief. Some families keep a main urn in one home and give small keepsakes to others; some scatter most ashes later but keep a symbolic portion close. If that approach fits your family, you can explore small cremation urns and keepsake urns, and read Funeral.com’s practical explanation of what keepsakes are and how much they hold in Keepsake Urns Explained.
Keeping ashes at home: comfort, safety, and family agreement
For many caregivers, the home has already become the center of the story—where care happened, where small moments of connection still live. It’s common, after cremation, to consider keeping ashes at home. Done thoughtfully, it can be comforting rather than unsettling, especially when the urn is placed somewhere safe, stable, and emotionally appropriate for the household.
If this is on your mind, Funeral.com’s guide keeping ashes at home walks through practical questions families ask—children, pets, visitors, long-term plans—so you don’t have to guess your way through it while grieving. It can also help to read what to do with ashes if your family is balancing multiple ideas at once.
Water burial and scattering: what families should know
Some families find that a natural setting fits the kind of goodbye dementia calls for—quiet, spacious, unforced. If you are considering water burial or scattering at sea, it helps to understand the basic rule that governs U.S. ocean burials. The U.S. Environmental Protection Agency explains that burial at sea under the general permit must occur at least three nautical miles from shore. Funeral.com’s planning guide Biodegradable Ocean & Water Burial Urns can help you think through timing, vessel style, and what will feel steady on the day.
Don’t forget the quiet grief: pet loss alongside dementia caregiving
One reality many families don’t talk about until it happens is that dementia seasons often overlap with other losses. A beloved pet may pass during years of caregiving, or shortly after—when the household finally goes quiet and the absence is loud. If your family is navigating that kind of layered grief, pet urns can be a gentle way to honor a companion without needing a grand decision. Funeral.com offers pet urns for ashes in many styles, including pet keepsake urns for sharing and pet figurine cremation urns that reflect a pet’s personality. If you want guidance first, the Journal article pet cremation urns sizing and personalization guide is written for real families who are trying to choose with love, not perfection.
Cremation jewelry and keepsakes for caregivers who need something close
Some caregivers describe an unexpected feeling after a long dementia journey: relief braided with grief and guilt. When the daily care ends, the body can feel untethered—like it doesn’t know what to do with its hands anymore. For some people, cremation jewelry becomes a quiet anchor: a small, wearable memorial that travels with you into ordinary life.
If that idea feels meaningful, you can explore Funeral.com’s cremation jewelry collection and the dedicated cremation necklaces collection, along with the practical Journal guide Cremation Jewelry Guide, which explains materials, filling tips, and what “waterproof” really means in everyday wear.
How much does cremation cost—and why dementia families benefit from clarity
When dementia has already stretched a family’s finances—home care hours, medical supplies, time off work—the cost question matters. If you’re trying to understand how much does cremation cost in a realistic way, Funeral.com’s how much does cremation cost guide breaks down direct cremation versus full-service options, common fees, and ways to compare quotes without feeling taken advantage of. Many families find that having even a loose plan—who to call, what paperwork you’ll need, what kind of memorial you want—reduces the likelihood of rushed spending during acute grief.
A gentle bottom line: readiness is about support, not surrender
If you take only one thing from this guide, let it be this: the FAST scale isn’t a verdict. It’s a vocabulary. It helps you describe what you’re already living, and it gives you a way to ask for the right level of support. When FAST stage 7 changes appear—especially the functional losses around FAST 7c hospice—it is not “too soon” to ask for help. It’s wise. It’s loving. And it can make the months ahead more humane for everyone in the house.
And when you’re ready—whether now or later—there is room for gentle funeral planning that honors the life behind the disease. Whether your family chooses a home urn, keepsake urns for sharing, cremation urns for ashes that become a steady centerpiece, or a scattering plan like water burial, you don’t have to do it perfectly. You only have to do it with care.
