Before your loved one officially begins Hospice Services, a few steps need to be completed:
First step: Your physician recommends hospice services and will write an order for Hospice Eval and Treat (must have for hospice services).
Second Step: Your physician usually has hospice agency information that they will provide to you or they will have a hospice agency representative (the Hospice Liaison) contact you via phone. If you are in the hospital, the liaison can come visit you at the hospital to give you information about their agency. The Hospice Liaison works for the Hospice Agency, not the hospital, and not for the physician. Most Hospice Liaisons get paid to get you to sign onto their agency so be sure to ask them the correct questions and get their contact information.
Third Step: The hospice agency will send a nurse to evaluate your loved one (and/or your loved one’s medical records) to see if your loved one truly qualify for hospice cares (advancing disease, terminal prognosis, no further treatment options, refusing further treatment options). Medicare has specific requirements that need to be met in order to qualify for, and begin, the Hospice Benefit. The hospice nurse will send her findings to the Medical Director of the Hospice Agency, who will determine if your loved one qualifies for the hospice benefit. And, if he/she does qualify, the Medical Director will determine the Terminal Diagnosis (the main reason your loved one will be on hospice services). You will get a call from a hospice representative with the final response. NOTE: If your loved one does not qualify, and you truly believe they need hospice services, reach out to another hospice agency for their opinion and for another/second evaluation.
Last Step: Once approved for hospice services, a representative from Hospice will contact you to answer questions you may have and to set-up a time for the Admission Visit (the Admission onto Hospice Services).
The HOSPICE ADMISSION VISIT will be about 1-2 hours in length and will consist of:
Paperwork
All paperwork related to the Hospice Benefit will need to be signed by the patient. However, if the patient has an Activated Power of Attorney (APOA), the Primary Agent will need to sign the paperwork (see section on Advanced Directives for information about APOA). These are the forms that will need to be signed and witnessed:
- Hospice Election Statement stating you are electing Hospice Cares and no longer wish to seek curative treatments.
- Admission Consent
- Advanced Directives (have copies of your Living Will and/or Health Care Power of Attorney, if you have them)
- HIPAA/Privacy
- Release of Information for Disaster Situations
- Rights & Responsibilities
- Consent for Treatment
- Client Evacuation Plan (in case of an emergency)
Social/Spiritual Assessment
The following items will be addressed during the Admission Visit:
- Future plans for Hospitalizations
- CPR/DNR
- Spiritual Needs (Church affiliation, spiritual distress, spiritual/religious needs)
- Spiritual and Existential Concerns
Physical Assessment by the Hospice Admission Nurse
The Admission Nurse (may be different than your assigned Hospice RNCM/Hospice Nurse) will address the following during the Admission Visit:
- Vital signs
- Skin check for wounds/sores
- Pain
- Shortness of Breath
- Medication List Review
- Safety issues
- Swallowing, eating, appetite
- Ambulation (how your loved ones gets around their home)
- Bowel habits
- Vital signs
- Plan of Care, preferences for End of Life Cares, Goals of Hospice
The Admission Nurse will provide you and your loved one information about how to call for assistance during after hours, when to call 911 and when not to call 911, medications that will be delivered, DME that will be delivered, safety issues in the home, and the names of your Hospice Team Members.
The Admission nurse will be giving you A LOT of information. And yes, it is A LOT to remember. You can use this website as a guide, but ALWAYS call your hospice team to clarify any information or details or instructions provided.
Hospice-101.com: Hospice for your Loved One 
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