When a life limiting incurable illness no longer responds to treatment, or when treatment severely diminishes the patient’s quality of life and the patient or their proxy has elected not to pursue further treatment, it’s time to consider hospice care.
Entering hospice early with weeks or months of life remaining rather than waiting until death is imminent gives both the patient and family caregivers time to take advantage of the many benefits hospice provides. In general, there are two ways to initiate care:
- Request a hospice referral from a physician who has been treating the patient.
- Make a “self-referral” by contacting a hospice provider directly.
In either case, the hospice provider must determine whether the patient is eligible to enroll in hospice care.
Federal rules require that patients have a life expectancy of six months or less if their condition runs its expected course. Hospice care can be extended indefinitely, so long as the patient continues to meet eligibility requirements.
Start the conversation early
Ideally, the potential for hospice care should be discussed soon after a life-threatening illness is diagnosed.
Ongoing talks with the healthcare team will help with planning and decision making, particularly about the success of treatment and goals of care. In cases of Alzheimer’s disease or dementia, hospice care is appropriate at the end stage of the disease process.
Read more about starting the conversation.
Get recommendations
If the patient’s physician agrees that hospice care would be appropriate and beneficial, ask for a list of hospice providers to evaluate, or request a direct referral to a provider the physician knows and trusts.
Have family, friends, or neighbors utilized hospice care? Ask them for recommendations, too, especially if there are a limited number of hospice providers in the area.
If the physician does not agree that hospice is the right choice, a self-referral can be made by contacting a local hospice provider directly. See a state listing of organizations that can answer questions about services/options or search for hospice providers by ZIP code.
Access providers
Request a no-cost, no-obligation visit with the hospice provider(s) that are being considered. A hospice team member will come to the patient’s home, hospital, nursing home, or assisted living facility to assess if they are eligible and answer questions.
If the patient is in a hospital, nursing home, or assisted living facility, the staff can help to set up the appointment(s).
If a nursing home has a contract with a hospice provider, it is not a requirement to use that provider for care. It is important to understand what the patient’s insurance — Medicare, Medicare Advantage, Medicaid, or other healthcare insurance — will cover.
Note: Patients with a Medicare Advantage plan receive hospice services through their regular Medicare benefit; the Advantage plan continues for other healthcare needs as long as premiums are paid.
Read suggestions for choosing a provider, including questions to ask. Review the Centers for Medicare and Medicaid’s quality measures for hospices.
Select a provider
Once you have chosen a hospice provider, the patient or someone legally authorized to act on their behalf will consent to proceed with admission into the hospice program. This may happen during the assessment visit with the hospice team.
Learn more about qualifying for hospice and the eligibility assessment visit.
Begin receiving services
If the patient meets eligibility requirements and agrees to hospice services, care can begin as soon as the consent form and other required documents are signed.
- If the patient is hospitalized, the hospice team will coordinate so that hospice services may begin once they are home – wherever that may be.
- The hospice team will determine what medical equipment and/or prescriptions will be needed and will arrange delivery of needed supplies (e.g., a hospital bed, oxygen, incontinence care consumables, etc.).
- During an initial meeting at the patient’s place of residence, the hospice team will develop a comprehensive plan for care. The meeting may include a discussion of family caregiving responsibilities, approaches to managing pain and other symptoms, and any dietary or safety concerns.
Learn what to expect during the first week of hospice care.
