Does Hospice Require a DNR?

No. Hospice does not require a Do-Not-Resuscitate (DNR) order. Nothing in Medicare's rules for starting hospice calls for one, so you can enroll and still want CPR, which is what “full code” means. Enrolling does not make someone a DNR either. A DNR is a separate medical order, and without one, emergency responders who are called may attempt CPR. Many hospice patients do choose a DNR, but that is their decision, not a condition of care.

What it actually takes to start hospice

For someone with Medicare Part A, two things. The hospice medical director or a hospice physician, plus the attending physician if the patient has one, certifies that life expectancy is six months or less if the illness runs its normal course. Then the patient or a representative signs an election statement. The federal list of what that statement must contain (42 CFR 418.24) covers the hospice and attending physician, an understanding that care is palliative rather than curative, which Medicare services are waived, the start date, cost sharing, Medicare's quality-review organization, and the signature. For elections starting on or after October 1, 2026, it also covers a written list of the items, services, and drugs the hospice will not cover. A DNR, CPR, and code status appear nowhere in it.

Does going on hospice automatically make someone a DNR?

No. Enrolling is not a medical order. A DNR has to be written by a doctor or other health care provider, after talking with the patient if possible, the health care proxy, or the family. MedlinePlus says a DNR may be part of a hospice care plan, not that it must be. So if someone calls 911 for a hospice patient with no DNR on hand, responders may start CPR. Which forms they will honor, such as an out-of-hospital DNR or a POLST, is set by each state, so ask the hospice which one applies where you live. See do you call 911 when someone dies at home on hospice.

Can you be full code on hospice?

Yes. Full code is the default: MedlinePlus says a person who wants CPR does not have to do anything, while a person who does not want it should talk with a provider about a DNR order. The hospice benefit is the same either way. In one study of 25,636 patients at two Michigan hospices from 2009 to 2014 (Ankuda and colleagues, Journal of Palliative Medicine, 2018), 12.9% were full code. Those patients were more likely to be discharged from hospice before they died, especially in the first two weeks. That finding is about leaving hospice care, not about living longer.

Can a hospice refuse to admit someone without a DNR?

Not on the grounds that Medicare requires one, and in some states not at all. Federal rules bar hospices from conditioning care on whether a person has signed an advance directive, such as a living will or health care power of attorney (42 CFR 489.102). CMS also tells its surveyors that a patient's choice not to write one, or what it says, should not affect admission to hospice. So a living will asking for CPR should not keep someone out.

Those rules are written about advance directives, and a DNR is a medical order rather than an advance directive, so they do not settle every dispute over a hospice's own DNR policy. Some states address it. Michigan law says a health facility or agency, a term that includes hospices, shall not require a do-not-resuscitate order as a condition of admission or services (MCL 333.20192). Ohio law says no health care facility, a term that includes hospice care programs, or other health care provider shall require a person to have DNR identification as a condition of receiving health care services (Ohio Rev. Code 2133.24). Florida's hospice rule goes only as far as advance directives: it bars conditioning treatment or admission on whether a patient has signed or waived one (Rule 59A-38.015). Ask your state survey agency what applies where you live. Having no DNR is also not on the federal list of reasons a hospice may discharge a patient (42 CFR 418.26).

What to do if a hospice says a DNR is mandatory

You do not have to sign anything that does not reflect your wishes just to be admitted. You have clear options:

• Ask to see the requirement in writing. Ask whether it comes from a law or from the hospice's own policy, and which one. A reputable agency can tell a recommendation from a requirement.
• Separate the two decisions out loud. Say plainly that you want to elect hospice and that code status is a separate conversation with the physician.
• Call another hospice. No federal rule stops a Medicare-certified hospice from admitting a full-code patient, so you can choose one whose approach fits.
• Involve the patient's own doctor, who can help you think through code status without the pressure of an admission deadline.
• Report it if you think it is wrong. Federal rules say complaints about advance directive requirements can go to the state survey and certification agency. See how to file a complaint about a hospice.

Feeling pressured on this point is also worth weighing when you compare providers.

What happens if a full-code hospice patient's heart stops?

Settle this with the hospice before it happens. Hospice staff visit; they are not in the home around the clock.

• At home, CPR usually has to come through 911. Brain damage or death can begin within about 4 minutes after blood flow stops, according to MedlinePlus, and an on-call nurse cannot get there that fast. For a patient who wants CPR, the realistic plan is to call 911, follow the dispatcher's instructions, and call the hospice as soon as you can.
• Ask what hospice staff would do during a visit. We found no federal rule that spells this out, so ask, and ask to see the hospice's written advance directive policy, which it must give you when care starts (42 CFR 418.52). Some states add to this: Florida requires hospices to give written information on their resuscitation policies at admission.
• In a nursing home, staff must act. Federal rules require nursing homes to provide basic life support, including CPR, until emergency responders arrive, subject to the resident's physician orders and advance directives (42 CFR 483.24).
• Ask about the bill. Medicare may not pay for an ER visit, hospital stay, or ambulance for the terminal illness unless the hospice arranged it, and you could owe the entire cost. Ask how the hospice would handle a 911 call made for CPR.
• A 911 call does not end hospice by itself. That takes a signed revocation statement from the patient or representative, or a discharge by the hospice.

Why the hospice keeps asking about CPR

Being asked is not being required. Hospices must record whether a patient has an advance directive (42 CFR 489.102), and CMS tracks whether they discussed or tried to discuss life-sustaining treatment preferences with each patient. That measure stood at 99.8% nationally for October 2024 through September 2025, so nearly every family gets the question. Because hospice is comfort-focused, the team may also recommend a DNR. A recommendation is not a rule, and those two things get blurred into the myth that a DNR is mandatory.

DNR vs. hospice election: two different decisions

They are often signed around the same time and easy to confuse:

	DNR order	Hospice election
What it is	A medical order about CPR	Choosing the Medicare hospice benefit for comfort-focused care
Who signs	A doctor or other health care provider writes it; state forms vary	Patient or representative (election statement)
Required for the other?	Not required to elect hospice	Not required to have a DNR
Reversible?	Yes, you can change your mind and ask for CPR	Yes, you can stop hospice at any time

You can have one without the other in any combination.

Why many hospice patients choose a DNR anyway

It helps to know what CPR involves. The National Institute on Aging says it means repeatedly pushing on the chest with force, which can sometimes break ribs, and it may include electric shocks and medicines. It also says CPR is less likely to work in older adults with chronic medical conditions or people hospitalized with a serious illness. A DNR declines only that. It has no instructions for other treatments, so pain medicine, other medicines, and comfort care continue. The choice stays with the patient and their physician, and hospice care proceeds either way. For more, see DNR orders explained for hospice families and does hospice mean giving up.

How code status fits with your other documents

The hospice team can help you complete or update any of these, and none of them is a precondition for starting care:

• Advance directive / living will: states your wishes and names a decision-maker. See advance directives and hospice.
• DNR order: a specific medical order about CPR.
• POLST / MOLST: portable medical orders that travel with the patient across settings. See POLST forms and hospice care.

Frequently asked questions

Does a DNR mean hospice will stop treating symptoms?

No. A DNR covers only CPR when the heart or breathing stops. Symptom relief and comfort care continue.

Can I change my code status after starting hospice?

Yes, in either direction. Someone who starts as full code can ask for a DNR later, and someone with a DNR always has the right to change their mind and ask for CPR. Tell the hospice team and your family right away, and destroy any old DNR documents so responders see current wishes.

What if my loved one does not want CPR but no DNR has been signed?

Ask the hospice team to help get the right form signed now. Until then, call the hospice, not 911, when death comes at home. If 911 is called, responders may attempt CPR because nothing tells them not to.

Do you have to be on hospice to have a DNR?

No. Someone near the end of life or with an illness that will not improve can choose whether to have CPR, whether or not they are on hospice.

Is it different with Medicaid, Medicare Advantage, or the VA?

Medicaid law holds hospice programs to the same rule against conditioning care on whether someone has signed an advance directive (42 U.S.C. 1396a(w)); see does Medicaid cover hospice. Once a Medicare Advantage member starts hospice, Original Medicare covers care for the terminal illness; see does Medicare Advantage cover hospice. VA policy (VHA Directive 1004.03) calls for a goals-of-care conversation around a hospice referral and does not list a DNR as a requirement; see hospice care for veterans.

Practical next step

You do not have to settle CPR before starting hospice. You can start now, keep your code status as it is, and take up the question with your physician on your own timeline. If you are comparing hospices, ask each one directly: “Do you admit patients who are full code, and what is your plan if a full-code patient's heart stops?” The answer tells you both the policy and how the agency communicates. Compare hospices near you and bring your advance directive, any existing DNR, and your questions to the first visit.