How to Get Hospice Care for a Parent: The Step-by-Step Process

Getting hospice care for a parent is a process that most families have never navigated before. The medical system can feel opaque at exactly the moment when you need it to be clear. Families sometimes delay because they are not sure whether their parent qualifies, who to call first, or whether asking for hospice means giving up.

This guide explains the process step by step, from the first conversation with the physician through the first days of care at home.

Step 1: Understand Who Qualifies

The eligibility criteria for hospice care (under Medicare, which covers most hospice in the United States) require that:

1. A physician certifies that the patient has a terminal illness with a life expectancy of six months or less if the disease follows its normal course
2. The patient and family agree to focus care on comfort rather than curative treatment for the terminal diagnosis
3. The patient elects the Medicare hospice benefit (or equivalent under Medicaid or private insurance)

The six-month prognosis is not a deadline — it is an eligibility threshold. Patients who live longer continue to receive care as long as they still meet the criteria. And patients do not have to stop all medical treatment; they simply cannot pursue curative treatment for their terminal diagnosis while on the hospice benefit. Treatment for other conditions (a separate chronic illness, for example) can continue.

Common diagnoses that qualify include: cancer, congestive heart failure, COPD, dementia, kidney failure, liver disease, and ALS. Any terminal illness can qualify if it meets the prognosis criteria.

If you are unsure whether your parent qualifies, the fastest way to find out is to call a hospice provider directly. They will typically conduct a free eligibility assessment.

Step 2: Have the Conversation with the Physician

The hospice process usually begins with a conversation with your parent's primary care physician or specialist.

The challenge: many physicians are reluctant to raise hospice first. They may be optimistic about the treatment trajectory, uncomfortable discussing death, or concerned about how the family will react. If you believe your parent is approaching end of life and hospice may be appropriate, you may need to raise it yourself.

You can say something like: "We've been thinking about quality of life and what the next few months might look like. Is hospice something we should be considering at this point?"

A physician who agrees that hospice is appropriate will write a referral — a formal order that initiates the hospice process. This referral goes to the hospice provider, who will then schedule an evaluation.

If the physician says your parent does not yet qualify but you believe they do, or if the physician seems reluctant to have the conversation, you can contact a hospice provider directly. Hospice intake staff are experienced at assessing eligibility and can advise you on whether to pursue a second opinion or wait.

Step 3: Choose a Hospice Provider

You are not required to use the hospice provider your physician or hospital recommends. You have the right to choose any Medicare-certified hospice provider in your area.

There are several types of hospice organizations:

• Nonprofit hospices, which often have longer histories and broader volunteer programs
• For-profit hospices, which make up an increasing share of providers
• Hospital-affiliated hospices, which may have stronger connections to inpatient care

Questions to ask when comparing providers:

• What is the average response time for an after-hours nurse call?
• How many nursing visits per week are included in the standard plan of care?
• Does the provider offer inpatient hospice care if symptoms cannot be managed at home?
• What is their aide/home health assistant availability?
• Do they have a physician on staff who will actively manage my parent's care, or does all medical management go through our current physician?
• What bereavement support do they offer families after death?

You can find Medicare-certified hospice providers using Medicare's Care Compare tool at medicare.gov/care-compare. Look at their quality ratings, but also call several providers and ask the questions above — the quality of a hospice provider is often felt in the responsiveness of their staff, not just their ratings.

Step 4: The Hospice Evaluation

Once you select a provider and your parent's physician has written a referral (or you have initiated contact directly), the hospice provider will schedule an evaluation at your parent's home or current location (hospital, nursing facility, assisted living).

During the evaluation, a hospice nurse or social worker will:

• Review your parent's diagnosis, current medications, and recent medical history
• Assess their symptoms and current functional status
• Explain the hospice benefit, what it covers, and what it does not
• Answer your questions about the care plan
• Have your parent (or their healthcare proxy, if they lack capacity) sign the hospice election form

The election form is the document by which your parent formally elects the Medicare hospice benefit. By signing it, they agree to receive comfort-focused care for their terminal illness rather than curative treatment for that diagnosis.

This evaluation visit typically lasts 1 to 2 hours. Come prepared with a list of your parent's current medications, their physician's contact information, their advance directive or POLST if they have one, and your questions.

Step 5: The Plan of Care Is Developed

Within 5 days of election, the hospice team develops a written plan of care covering services, visit frequency, medications, and goals. The interdisciplinary team includes a physician (medical director), registered nurses (on call 24/7), home health aides, a social worker, and optionally chaplains and volunteers. The plan is reassessed every 15 days initially and at each benefit period recertification.

Step 6: Equipment and Medications Are Delivered

One often-surprising benefit: the hospice provider arranges delivery of medical equipment (hospital bed, commode, wheelchair, oxygen) and covers medications related to the terminal diagnosis — pain medications, anti-anxiety medications, nausea medications. Medications for separate, unrelated conditions continue through regular Medicare Part D.

What Hospice Does Not Do

Understanding the limits prevents surprises:

• Hospice does not provide 24-hour care in the home. Family or hired caregivers remain responsible for the majority of daily care. Hospice provides scheduled visits and on-call nurse access, not continuous presence.
• Hospice does not cover curative treatment for the terminal diagnosis.
• Hospice does not prevent a family from calling 911 — but if they do, paramedics may initiate resuscitation unless a valid DNR or POLST is present.

If symptoms cannot be managed at home, inpatient hospice care is available at a hospice facility or contracted hospital — covered by the hospice benefit for acute management.

The Fastest Path When Time Is Short

If your parent has just been given a terminal diagnosis or was told at a hospital discharge that "there is nothing more to do," the referral-to-enrollment timeline can be very fast — often same day or next day in urgent situations.

Do not wait to start the process because you are worried about overwhelming the family or because it feels premature. Research consistently shows that earlier hospice enrollment results in better symptom control and better outcomes for both patients and caregivers. Many families say their greatest regret is not enrolling sooner.

If your parent is currently hospitalized, ask the hospital social worker or case manager to initiate a hospice referral before discharge. Hospice providers frequently work directly with hospitals to ensure continuity of care.

Making the Decision as a Family

The decision to elect hospice is rarely made by one person. It involves the patient (if they have capacity), their healthcare proxy, and often multiple family members — who may be at different stages of accepting the prognosis.

Our End-of-Life Planning Workbook includes a section on goals-of-care conversations — how to discuss quality of life versus quantity of life, how to frame the hospice conversation with a parent who may be resistant, and how to coordinate as a family when siblings disagree. It also includes worksheets for documenting your parent's wishes so that the hospice team understands their priorities from day one of enrollment.

The hospice intake process itself is manageable. What makes it harder is doing it without having talked to your parent about what they want. The time to have that conversation is before a crisis forces the decision.