What happens in the first 72 hours of hospice?
The short answer
After a referral, a hospice nurse visits to explain the services, go over the consent forms, and assess your loved one. Medicare rules require that first nursing assessment within 48 hours of signing up, and the full team assessment within 5 days. Over those first days, equipment and medicines arrive and you start to meet the team.
General information, not medical advice. Your hospice team knows your person and can answer for your situation.
From referral to the first visit
A doctor, hospital, or your family contacts the hospice. Someone from the hospice calls to set up a visit, often at home, in the hospital, or in the facility where your person lives.
That visit can feel like a lot. It's fine to ask the nurse to slow down, or to have a second family member take notes.
The paperwork
To start hospice under Medicare, a few things happen:
- The hospice doctor, and your person's regular doctor if they have one, certify that your loved one is expected to live 6 months or less if the illness runs its usual course.
- Your person, or the person who makes decisions for them, signs a statement choosing comfort care through hospice instead of treatment aimed at curing the illness.
- You can name a regular doctor, nurse practitioner, or physician assistant to stay involved as the attending.
Signing does not lock you in. Your person can stop hospice at any time.
The assessment and the plan of care
The nurse checks pain, breathing, skin, eating, sleep, and medicines. Within 48 hours of signing, a hospice nurse must complete this first assessment. Within 5 days, the wider team, which can include a doctor, social worker, chaplain, and aide, must complete a fuller one.
Together with you, they build a plan of care. It sets out which visits, services, medicines, and equipment your loved one will get.
What gets delivered
Depending on the plan, the hospice provides:
- Medical equipment, like a wheelchair or walker
- Supplies, like bandages and catheters
- Medicines for pain and other symptoms, for which you pay up to $5 per prescription
Ask the nurse which medicines will be kept in the home for sudden symptoms at night, and how to use them.
What you should know by day three
By the end of the first few days, you should be able to answer these:
- What is the 24/7 phone number, and when should we call it?
- How often will the nurse and the aide visit?
- Who is our main nurse?
- Which old medicines are stopping, and which new ones are starting?
- What equipment is still on the way?
A hospice nurse and doctor are on call 24 hours a day, 7 days a week. Put that number on the fridge and in every family member's phone. If anything is unclear, call.
If you are still deciding between hospices, our article on how to choose a hospice lists questions to ask first.
Sources
- Medicare.gov, Medicare Hospice Benefits booklet: medicare.gov/publications/02154-medicare-hospice-benefits.pdf
- Medicare.gov, Hospice care: medicare.gov/coverage/hospice-care
- 42 CFR 418.54, Initial and comprehensive assessment of the patient: law.cornell.edu/cfr/text/42/418.54
Educational information only. This article is not medical, legal, or financial advice, and it can't account for your person's health or your state's rules. Always talk with your hospice team, doctor, or Medicare (1-800-MEDICARE) about your situation. If you think it's an emergency, call your hospice's 24-hour number or 911.