Hospice and Power of Attorney

You do not need a power of attorney (POA) to start hospice. A patient who can make their own decisions signs the hospice election themselves. If they can't, Medicare lets a representative sign for them: someone with authority under state law to make medical decisions on their behalf, such as the agent named in a healthcare power of attorney or a court-appointed guardian. A financial POA on its own does not give that authority.

Quick answers

• Do we need a POA before hospice can start? No. If the patient can decide, they sign. If they can't, a healthcare agent or the surrogate your state's law allows signs.
• Can the healthcare POA sign the hospice paperwork? Yes. A healthcare agent can sign the election statement and, later, can revoke it if that is what the patient would want.
• Does a financial POA count? No. It covers money and property, not medical decisions.
• She is on morphine. Can she still sign? Possibly. Morphine does not automatically remove the ability to decide; see the next section.
• Is it too late to get a POA now? Not if the patient can still understand and communicate the choice.
• Does a POA still work after death? A financial agent's authority ends when the person dies. Whether a healthcare agent has any say over arrangements after death depends on your state's law.

Can someone on morphine sign a POA or the hospice papers?

Often yes, if they can understand and communicate the decision at the moment they sign. Being on morphine, or being on hospice, does not by itself take away a person's right to make their own choices. What matters is decision-making capacity for that specific decision at that time. Morphine can make people drowsy, and serious illness can bring on confusion that comes and goes, so timing matters: ask the hospice nurse when your loved one is usually most alert, and don't skip or delay pain medicine on your own to make them more alert. The hospice physician or nurse can tell you whether they think your loved one can make the decision. If she can't, she can't sign a new POA, and decisions fall to anyone she already named, to the surrogate allowed by your state's law, or to a court-appointed guardian.

Is it too late to get a POA once someone is on hospice?

No, as long as the patient still has capacity. A person can sign a healthcare power of attorney, change who they named, or cancel an old one while on hospice. Each state has its own form and signing rules, such as witnesses or a notary, so ask the hospice social worker what your state uses. If the patient has already lost capacity, a new POA can't be signed, and the default rules described below apply.

The two kinds of power of attorney

People often say "POA" as if it's one thing, but there are two very different documents:

• Healthcare power of attorney (also called a healthcare proxy or medical POA): names someone to make medical decisions — including electing hospice — if the patient loses the capacity to decide for themselves.
• Financial (durable) power of attorney: covers money, bills, and property. It does not grant authority over medical care.

For hospice decisions, the healthcare POA is the one that counts. A person can have one, the other, both, or neither, and it is fine to name one person as healthcare agent and a different person to handle finances. The financial agent may still be busy during hospice: Medicare's hospice benefit does not pay room and board, including in a nursing home, so a financial agent may be the one handling those bills.

Who signs the hospice election?

If the patient has decision-making capacity, they sign the hospice election statement — no POA needed. If they lack capacity, the person named in the healthcare POA (or, if there is none, a surrogate or guardian with authority under state law) signs on their behalf. The hospice team and physician assess capacity at admission.

For hospice elections that begin on or after October 1, 2026, the hospice must also give the patient or representative a written addendum titled "Patient Notification of Hospice Non-Covered Items, Services, and Drugs" within the first 5 days of the election. It lists anything the hospice has decided is unrelated to the terminal illness and will not cover, with an explanation in plain language. Signing it only confirms you received it; it does not mean you agree. If you disagree, the addendum explains how to ask the Medicare BFCC-QIO for immediate advocacy. More in our guides on the hospice election statement and advance directives and hospice.

Can a POA take someone off hospice?

Yes. Under Medicare rules, the patient or their representative can revoke the hospice election at any time by giving the hospice a signed statement with the date it takes effect (which can't be earlier than the day it is signed). Regular Medicare coverage for the terminal illness resumes, and the patient can elect hospice again later if still eligible. As with every decision an agent makes, the test is what the patient would want, not what the agent prefers.

What "capacity" means and who decides it

Capacity is not all-or-nothing, and it is not the same as having a dementia diagnosis or being elderly. In medical terms, a person has decision-making capacity if they can understand the relevant information, appreciate how it applies to their situation, reason through the choices, and communicate a consistent decision. Many people with early or moderate dementia can still choose hospice; some people with delirium from infection lose and then regain capacity. The hospice physician and admitting nurse assess capacity for the specific decision at the time it is being made. When capacity is borderline or fluctuating, the team involves the patient as much as possible while having the named agent ready to act.

What happens when there is no document at all

Families often arrive at hospice intake with no POA and no advance directive, and worry that this will block enrollment. It usually does not. Most states, though not all, have a "default surrogate" law that lists who may make medical decisions for an adult who has lost capacity and named no one. Many of these lists start with a spouse, then adult children, then parents, then siblings, but the order and who qualifies vary by state. The hospice social worker can explain your state's rules, including what to do if your state has no such law. The downside of relying on the default law is ambiguity: if several adult children disagree, there is no single named agent to break the tie. That is the real value a healthcare POA adds: it settles who speaks.

How POA works alongside advance directives

A healthcare POA names the decision-maker; an advance directive (living will) states the patient's wishes. They work best together. See advance directives and hospice and DNR orders explained — note that hospice does not require a DNR. The clearest setup is a healthcare POA naming a single agent, paired with a living will or POLST that spells out preferences, so the agent has both the authority to act and a written guide to what the patient wanted.

Healthcare POA vs. financial POA vs. living will: a quick comparison

When the agent and the patient see things differently

In most healthcare POAs, the agent acts only when the patient can't decide; while the patient can, the patient's own choice controls. When the agent does decide, the job is to make the decision the patient would have made, not the one the agent personally prefers — a standard lawyers call "substituted judgment." That means leaning on whatever the patient said before, any living will, and what you know of their values. If the patient expressed clear wishes (for example, "no machines, keep me comfortable at home"), the agent honors them even if part of them wishes for more time. If the patient never said, the agent decides based on the person's overall values and best interest. The hospice social worker and chaplain are there to help an agent carry this; you are interpreting a loved one's wishes, not choosing for them in a vacuum.

Frequently asked questions

Can the financial POA sign hospice paperwork?

Not for medical decisions. A financial (durable) POA covers money and property only. If the patient lacks capacity, the healthcare agent — or the surrogate your state's law allows — signs the hospice election, even if a different person holds the financial POA.

Can the healthcare agent see medical records and talk to the hospice team?

Yes, for decisions they are authorized to make. Under the federal HIPAA Privacy Rule, a person with legal authority to make health care decisions for an adult must be treated as that adult's "personal representative" for the health information relevant to that role.

My parent has dementia. Can they still sign themselves?

Possibly. A dementia diagnosis does not automatically remove capacity. If your parent can understand and communicate the decision at the time it's being made, they may sign. The hospice physician assesses this; if capacity is lost, the healthcare agent or surrogate signs instead.

What if family members disagree about hospice?

If there is a named healthcare agent, that person has the legal authority to decide, which is why naming one helps. Without a document, your state's surrogate rules apply, and the hospice social worker can help mediate. Disagreement does not have to stall care, but a clear POA prevents most of it.

Does a power of attorney still work after the person dies?

No. A financial agent's authority ends at the moment of death, and the agent should stop paying bills or managing accounts and notify the bank and other businesses they dealt with. Ask the funeral home or an attorney who has authority over arrangements and the estate under your state's law.

Does a POA expire or need to be from my state?

A healthcare POA generally remains valid until revoked, but rules on out-of-state documents vary. If you've moved or the document is old, ask the hospice social worker or an elder-law attorney whether it should be refreshed.

Practical next steps

• If your loved one still has capacity, have them complete a healthcare POA now, while they can choose their agent, timed for when they are most alert.
• Bring any POA or advance-directive documents to the hospice intake visit.
• If no document exists and capacity is already lost, ask the hospice social worker about your state's surrogate-decision rules.
• Keep the financial and healthcare documents separate in your mind, and know which person holds each role.

This is general information, not legal advice; an elder-law attorney or the hospice social worker can confirm what your state requires. When you're ready, you can compare Medicare-certified hospices near you and ask each one how they handle decision-making and intake paperwork. For the enrollment steps themselves, see how to enroll a loved one in hospice.