Guidelines for Use of the Functional Assessment Staging Scale - FAST

Oct 4, 2026

Guidelines explain how to use the Functional Assessment Staging Scale (FAST) to quantify disability severity and track changes over time. FAST is intended as a screening tool and not as the sole basis for diagnosing dementia or differentiating dementia types. Patients in Stage Seven are considered end stage and appropriate for hospice, with survival varying by comorbidities and care comprehensiveness. The document also links FAST scoring with MMSE and provides steps for completion, documentation, and scoring levels.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages3

Reading Time8 min

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Introduction

When is the FAST to be completed?

How to complete the FAST assessment

Functional Assessment Staging Test (FAST)

References

Guidelines for Use of the Functional Assessment Staging Scale Introduction The Functional Assessment Staging Scale (FAST) is a screening test to quantitatively assess the degree of disability and to document changes that occur over time. It isnot intended to serve as the sole criterion for diagnosing dementia or to differentiate between various forms of dementia. According to the National Hospice & Palliative Care Organization’s Medical Guidelines, patients classified as Stage Seven of the FAST are those who are considered end stage and appropriate for hospice. Even severely demented patients may have a prognosis of up to two years. Survival time depends on variables such as the incidence of co-morbidities and the comprehensiveness of care. The FAST has scores which have been correlated with scores on the Mini Mental State Examination (MMSE) . It is therefore a useful tool to support findings of the FAST scale. When is the FAST to be completed? The FAST should be completed on admission of any patient with Dementia/Alzheimer’s Disease as the primary or secondary diagnosis. This should be documented on the Dementia Clinical Summary. 1. For each Dementia/Alzheimer’s patient for each recertification period. The score is to be documented on the Dementia Clinical Summary. 2. Anytime a patient’s cognitive function would be considered a prognostic indicator for survival or anytime there are significant changes in status. The score is then documented in the clinical note. 3. The FAST may also be completed for patients who have a coexisting cognitive impairment which may impact quality of life and survival. The score is then documented in the clinical note. How to complete the FAST assessment 1. Nurses, psychosocial professionals, and physicians may complete the FAST assessment. 2. Review FAST form and annotated guidelines for scoring (see below) . 3. Based on interview with patient/caregivers and observation, identify the highest consecutive level of disability based on guidelines. 4. Document score on the Dementia Clinical Summary. Functional Assessment Staging Test Following the admission process, when possible, the same health care provider should administer the scale on subsequent evaluations. The tool “Typical Time Course of Alzheimer’s Disease” is a helpful reference to use Guidelines for Use of the Functional Assessment Staging Scale once the FAST score has been established. Once the score has been determined, score placement on the tool can help to identify the usual time course of the disease and progression towards death. The “Typical Time Course of Alzheimer’s Disease” tool is only a reference and does not need to be completed or included in documentation. Functional Assessment Staging Test (FAST) 1. No difficulty either subjectively or objectively. 2. Complains of forgetting location of objects. Subject work difficulties. 3. Decreased job functioning evident to co-workers. Difficulty in traveling to new locations. Decreased organizational capacity.* 4. Decreased ability to perform complex tasks, e.g., planning dinner for guests, handling personal finances (such as forgetting to pay bills), difficulty marketing, etc. 5. Requires assistance in choosing proper clothing to wear for the day, season or occasion, e.g., Patient may wear the same clothing repeatedly, unless supervised.* 6. a. Improperly putting on clothing without assistance or cueing (e.g., may put street clothes on overnight clothes, or put shoes on wrong feet, or have difficulty buttoning clothing) occasionally or more frequently over the past weeks. b. Unable to bathe properly (e.g., difficulty adjusting bath-water temperature) occasionally or more frequently over the last weeks. c. Inability to handle mechanics of toileting (e.g., forgets to flush the toilet, does not wipe properly or properly dispose of toilet tissue) occasionally or more frequently over the past weeks. d. Urinary incontinence (occasional

FAQs

What is the Functional Assessment Staging Scale (FAST) used for?

FAST is a screening test to quantitatively assess the degree of disability and document changes over time. It supports clinical findings but is not intended as the sole criterion for diagnosing dementia or differentiating dementia forms.

When should FAST be completed and where should scores be documented?

FAST should be completed at admission for patients with Dementia/Alzheimer’s as a primary or secondary diagnosis, and then for each recertification period. It should also be updated when cognitive function is a prognostic survival indicator or when significant status changes occur, with scores documented on the Dementia Clinical Summary or in the clinical note.

Who can administer the FAST assessment and what is the scoring process?

Nurses, psychosocial professionals, and physicians may complete FAST. The process uses review of the FAST form and scoring guidelines, then interview with the patient/caregivers and observation to identify the highest consecutive level of disability, which is then documented.

Oct 4, 2026

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