Hospice Intake: What Happens on Day One

On the first day of hospice, an admission nurse visits wherever your loved one lives, completes a head-to-toe assessment, helps you sign the election statement and consent forms, and starts an initial plan of comfort care. The visit usually takes one to two hours, and the goal is to relieve symptoms quickly and set up support, not to overwhelm you with paperwork.

Who shows up

The first visit is typically led by a registered nurse. Over the first few days you will also meet other members of the interdisciplinary team: a home health aide, a medical social worker, a chaplain (if wanted), and volunteers, all overseen by the hospice physician. You do not meet everyone on day one; the team rolls in over the first week.

The clinical assessment

The nurse reviews the diagnosis, current symptoms, pain level, medications, and what your loved one can still do for themselves. This assessment shapes the plan of care and identifies what comfort medications and equipment are needed right away. Bring your medication bottles and the items from our guide on documents you need to start hospice so this goes smoothly.

The paperwork you sign

• Election statement: the patient or legal representative formally chooses the hospice benefit and this specific provider.
• Consent to care and a privacy notice.
• Release of medical information so the team can coordinate with prior doctors.
• Financial/insurance acknowledgment confirming how the benefit works.

The team will also ask about advance directives and code-status wishes. Remember, hospice does not require a DNR; that is a separate, personal decision.

A rough timeline of the first visit

Every admission is a little different, but most follow a recognizable arc so you know what to expect:

• First 15–30 minutes — introductions and consent. The nurse explains who they are, how hospice works, and walks through the election statement and consents before anything else.
• Next 30–45 minutes — the clinical assessment. A head-to-toe check, review of symptoms and the full medication list, and questions about daily function and goals of care.
• Following stretch — the plan and orders. The nurse drafts the initial plan of care, contacts the hospice physician for medication and equipment orders, and arranges deliveries.
• Before leaving — setup and contacts. You get the 24/7 on-call number, instructions for the comfort kit, and a sense of when the next visits and other team members will come.

The initial plan of care

Before leaving, the nurse drafts an initial plan of care, the roadmap for symptoms, visit frequency, equipment, and goals. Our guide on the hospice plan of care explains how it works and how you stay involved. The full interdisciplinary plan is finalized within a few days as other team members complete their assessments.

Medications and equipment

The hospice arranges delivery of comfort medications for the terminal illness and any needed durable medical equipment, such as a hospital bed, oxygen, a wheelchair, or a bedside commode, often the same day or next day. Under Medicare, terminal-illness drugs carry a copay of no more than $5 per prescription, and equipment for the terminal illness is covered. Many families receive a small "comfort kit" of emergency medications to keep on hand for symptoms that flare after hours.

How you reach the team

You will be given a 24/7 on-call phone number. A common misconception is that hospice means a caregiver stays in the home around the clock, it does not. Visits are intermittent, but the phone line is staffed day and night, and a nurse can come out for a crisis. If your loved one dies at home, you call the hospice, not 911.

How to prepare so day one goes smoothly

A little preparation turns a stressful first visit into a manageable one:

• Gather every medication bottle — prescription, over-the-counter, vitamins — in one place for the nurse to review.
• Have ID, insurance/Medicare cards, and any advance directive or POLST ready in a folder.
• Pick one family point of contact so instructions don't get scrambled across relatives.
• Clear a path and a surface for any equipment being delivered, like room for a hospital bed.
• Write down your top questions in advance — it's easy to forget them in the moment.

What the comfort kit is for

The small "comfort kit" (also called an emergency or e-kit) left in the home is one of the most useful parts of day one. It holds medications to treat symptoms that flare suddenly — typically options for pain and breathlessness, anxiety or agitation, nausea, and noisy secretions. The idea is that when something changes at 11 p.m., you can call the on-call nurse, who will tell you exactly what to give and how much, instead of waiting for a pharmacy or heading to the ER. Keep the kit in one known, secure spot, and never use anything in it without the nurse's instruction. Write down what you give and when, so the team can fine-tune the plan at the next visit.

The first week after day one

Admission is the start of a rhythm, not the whole picture. Over the next several days the rest of the team completes their assessments and the plan of care is finalized:

• The aide begins scheduled visits for bathing and personal care.
• The social worker checks in on practical and emotional needs, paperwork, and family support.
• The chaplain offers spiritual support if your family wants it — it is always optional.
• The nurse settles into a visit schedule matched to your loved one's needs, adjusting medications as symptoms change.

The emotional side

Day one can feel like a lot. It is normal to feel relief, grief, or both. The social worker and chaplain are there for the whole family, and bereavement support is part of the benefit. Our guide on the first 48 hours of hospice walks through what comes next.

Frequently asked questions

How long does the first visit take?

Usually one to two hours. It is longer than later visits because of the full assessment and paperwork, but the nurse paces it to what your loved one can tolerate.

Do we have to sign a DNR on day one?

No. Hospice does not require a DNR. The team will ask about your wishes and any advance directive, but code status is a separate, personal decision.

Can we still keep our own doctor?

Often yes — many patients keep their attending physician, who works alongside the hospice team. Confirm the arrangement during intake.

What if a symptom flares the first night?

Call the 24/7 on-call line, not 911. That's what the comfort kit and the after-hours nurse are for; a nurse can guide you by phone or come out.

Can my loved one leave hospice later if they change their mind?

Yes. A patient can revoke the hospice election at any time and return to standard Medicare coverage.

Your practical next step

Have your folder of documents ready, write down questions in advance, and pick one family member to be the main point of contact for the team. If you have not chosen a provider yet, our guide on how to enroll a loved one in hospice covers the steps, and you can compare hospices near you on quality and family-survey scores first.