Setting up hospice care at home typically begins with a conversation with your loved one’s doctor and can be fully in place within a few days. The process involves choosing a hospice provider, completing some paperwork, and preparing your home for the care team and equipment that will follow. While it can feel overwhelming during an already difficult time, hospice agencies handle most of the logistics once you get the process started.
Who Qualifies for Home Hospice
To qualify for hospice under Medicare (and most private insurance), a physician must certify that the patient has a life expectancy of six months or less if the illness follows its normal course. This doesn’t mean the patient has exactly six months to live. It means the doctor’s best clinical judgment, based on the disease trajectory and the patient’s current condition, points to that timeline. Patients who live longer than six months can continue receiving hospice care as long as a doctor recertifies that the prognosis still applies.
The other key requirement: the patient (or their healthcare decision-maker) agrees to shift the focus of care from curative treatment to comfort. This is a formal election, meaning the patient chooses hospice and signs paperwork acknowledging that choice. It’s reversible. If the patient later decides to pursue curative treatment, they can leave hospice and return to standard care at any time.
How to Start the Process
You don’t need to wait for a doctor to bring it up. A patient, family member, or friend can request a hospice referral. Here’s the general sequence:
- Talk to the patient’s doctor. The physician needs to provide a referral and eventually certify the terminal prognosis. If the doctor hasn’t mentioned hospice, ask directly whether your loved one might benefit from it.
- Choose a hospice provider. You’re not locked into whatever agency the hospital or doctor suggests. You can compare providers, interview them, and pick the one that fits best.
- Schedule an intake evaluation. The hospice agency sends a nurse to assess the patient’s condition, discuss symptoms, and begin building a care plan. This visit usually happens in the home.
- Complete admission paperwork. This includes consent forms, the hospice election form, and a review of any advance directives.
- Receive equipment and medications. The agency arranges delivery of a hospital bed, oxygen, and other supplies based on the care plan. This often happens within 24 to 48 hours of admission.
From the first phone call to having a full care team in place, the timeline is usually just a few days. In urgent situations, some agencies can complete same-day admissions.
Choosing the Right Hospice Provider
Not all hospice agencies operate the same way, and the quality of your experience will depend heavily on which one you choose. Medicare publishes a Care Compare tool online where you can look up agencies in your area and see quality ratings. Beyond that, ask specific questions before committing.
Focus on availability first. Ask how many patients each nurse is assigned, whether you’ll see the same nurse regularly, and what happens after business hours, on weekends, and on holidays. Find out how quickly someone responds when you call with an urgent need. These details matter far more than a polished brochure.
Ask about symptom management: how the team handles pain that isn’t well controlled, whether the patient can continue current medications, and what happens if symptoms become unmanageable at home. Ask whether you can still see the patient’s regular doctor and how the hospice team will coordinate with them. Finally, ask about caregiver support: what respite options exist, what emotional and bereavement services are offered, and whether you can speak with other families who’ve used the agency.
What the Hospice Team Does
Home hospice doesn’t mean someone moves into your house around the clock. The team visits on a scheduled basis and is available by phone between visits. The core team includes a nurse, a social worker, a chaplain or spiritual counselor, a home health aide, and a supervising physician. Some agencies also include dietitians, pharmacists, and bereavement counselors.
The nurse is the most frequent visitor and the central point of contact. They assess the patient’s symptoms, adjust the care plan, manage medications, and communicate changes to the rest of the team. The social worker helps with emotional support, connects the family to community resources, and assists with practical concerns like insurance questions or family dynamics. The chaplain addresses spiritual needs based on the patient’s own beliefs, not a particular religious tradition. Home health aides help with bathing, grooming, and other personal care tasks, typically visiting a few times per week.
Volunteers are also part of the hospice model. They might sit with the patient so you can step out, help with light household tasks, or simply provide companionship.
What Family Caregivers Handle
This is the part that catches many families off guard. Between scheduled visits from the hospice team, the family caregiver provides the majority of direct, day-to-day care. That includes giving medications on schedule, helping with eating and drinking, repositioning the patient to prevent pressure sores, assisting with toileting, and monitoring for changes in symptoms or comfort level.
The hospice team trains you on all of this. They’ll show you how to administer medications, what signs to watch for, and when to call. But the hands-on responsibility between visits falls on you or whoever is serving as the primary caregiver. It’s physically and emotionally demanding work, and it’s worth having an honest conversation with your family about whether you have enough people to share the load before choosing home hospice over a facility-based option.
Equipment and Medications Provided
The hospice agency supplies medical equipment based on what the patient needs. Common items include a hospital bed with a pressure-relief mattress, oxygen and delivery devices, a bedside commode, walkers or wheelchairs, a patient lift, and suction equipment. If the patient needs a feeding pump, nebulizer, or CPAP machine, those are provided as well. The agency handles delivery, setup, and maintenance.
Medications related to the terminal illness and symptom management are also covered. Most patients receive what’s sometimes called a comfort kit at admission: a small supply of medications kept in the home for symptom emergencies. A typical kit includes something for pain, nausea, anxiety, restlessness, and excess secretions. The hospice nurse will walk you through each medication, explain what it’s for, and tell you when and how to use it. You won’t be expected to make those decisions on your own.
Preparing Your Home
You don’t need to renovate, but some practical adjustments help. The patient’s room should be on a level that’s easy to access, ideally near a bathroom. Clear enough floor space for a hospital bed and room for the care team to work on both sides of it. Make sure there’s an accessible electrical outlet for oxygen or other equipment.
Stock the bathroom with supplies for personal care. Keep a notebook or whiteboard near the bed to track medications, visit schedules, and symptom changes. Have a phone charger nearby, because you’ll be calling the hospice line more than you expect. If the home has stairs the patient would need to navigate, discuss alternatives with the hospice team during the intake visit.
The Paperwork You’ll Need
Admission involves several forms. You’ll sign a hospice election form, which formally enrolls the patient. You’ll also review or create advance directives, the legal documents that spell out what the patient wants if they can no longer speak for themselves.
The two most important advance directives are a living will and a healthcare power of attorney. A living will states which medical treatments the patient does and does not want to sustain their life. A healthcare power of attorney names a specific person to make medical decisions on the patient’s behalf when they can’t. Each state has its own forms and requirements. Some require a witness signature, others require notarization.
If the patient wants a do-not-resuscitate (DNR) order, they simply tell their doctor, who writes it into the medical record. No separate legal document is needed. Some states also use a form called POLST (Provider Orders for Life-Sustaining Treatment), which translates the patient’s wishes into medical orders. If you have a POLST, place it somewhere visible in the home, like on the refrigerator, so emergency responders can find it.
Four Levels of Hospice Care
Home hospice isn’t a single, fixed level of service. Medicare defines four levels, and the patient can move between them as needs change.
- Routine home care is the most common level. The patient’s symptoms are reasonably controlled, and the team visits on a regular schedule.
- Continuous home care kicks in during a crisis, like severe uncontrolled pain or acute respiratory distress. A nurse stays in the home for extended hours (a minimum of eight hours in a 24-hour period) to stabilize the situation.
- General inpatient care is also for crisis-level symptoms but takes place in a hospital or inpatient facility when the problem can’t be managed at home.
- Respite care is designed for the caregiver, not the patient. The patient temporarily moves to a facility so the person providing daily care can rest. Medicare covers up to five consecutive days of respite care at a time.
What It Costs
If the patient has Medicare Part A, hospice care is covered with almost no out-of-pocket cost. You pay nothing for nursing visits, equipment, supplies, or the core services of the hospice team. The only costs are a copay of up to $5 per prescription for symptom-management medications and a 5% coinsurance for inpatient respite care. Most Medicaid programs cover hospice similarly. Private insurance plans vary, but the majority include a hospice benefit. Call your insurer to confirm the details before choosing a provider.
One important note: Medicare hospice coverage does not pay for room and board if the patient lives in a nursing home. It covers the hospice services layered on top of the facility’s care, but the facility charges remain separate.