How to Enroll a Loved One in Hospice

Enrolling a loved one in hospice generally takes four steps: get a physician's certification that the illness is terminal, choose a Medicare-certified hospice, complete a hospice evaluation, and sign the election statement to start care. The whole process can move quickly, sometimes within a day, and you do not need to wait for a hospital discharge or a long approval to begin.

Who can be enrolled

To elect the Medicare hospice benefit, a physician must certify that the person has a terminal illness with a life expectancy of about 6 months or less if the disease runs its normal course, and the patient (or their decision-maker) must choose comfort care over curative treatment for that illness. Eligibility is a physician's clinical judgment, not a family checklist, so the right move is to request a free hospice evaluation rather than assume you do or do not "qualify." For who fits, see who qualifies for hospice care.

The four steps to enroll

1. Get a physician referral and certification

Start by talking with the treating doctor; they (and the hospice medical director) certify terminal prognosis. Anyone, family, patient, or hospital staff, can contact a hospice to ask for an evaluation, but a physician's certification is required to begin care. If you are unsure how to raise the subject, read how to talk to a doctor about hospice.

2. Choose a hospice provider

You have the right to choose your hospice. Compare providers on quality, services, after-hours support, and family-survey scores. Medicare's Care Compare publishes CAHPS family ratings and quality measures to help. Confirm the agency is Medicare-certified. A structured method lives in how to choose a hospice provider.

3. Complete the hospice evaluation

A hospice nurse visits, usually at home, hospital, or facility, to assess needs, explain the benefit, and answer questions. There is no cost to ask for this visit. Learn what happens in what happens at a hospice evaluation.

4. Sign the election statement

To start, the patient or their authorized representative signs a hospice election statement, choosing the hospice benefit and a specific provider. This is the document that formally begins care; understand it in what am I signing.

How fast can enrollment happen?

Faster than most families expect. Once a physician is willing to certify the terminal prognosis and you have chosen an agency, many hospices can complete the evaluation and admit the same day or the next, including evenings and weekends for urgent situations — see same-day hospice admission. There is no waiting period, no prior-authorization delay built into the Medicare benefit, and no requirement to be discharged from the hospital first. If your loved one is being released from a hospital, the discharge planner can begin the referral so a hospice can meet you at home; you still choose which agency, and you can move a loved one straight from the hospital — see moving a loved one into hospice from the hospital.

Who signs if the patient cannot

If the patient is alert and capable, they sign the election statement themselves. If they cannot — because of advanced dementia, unconsciousness, or another reason — their authorized representative signs on their behalf. This is usually the person named in a healthcare power of attorney, or, if none exists, the legal next of kin recognized under state law. Bring the power-of-attorney or healthcare-proxy document to the evaluation if one exists. This matters because the election statement is a real decision to choose the hospice benefit for the terminal illness; the signer should understand it. See hospice and power of attorney and advance directives and hospice.

What you'll need on hand

• Insurance information (Medicare, Medicaid, Medicare Advantage, or private plan)
• A list of medications and the treating physician's contact
• Any advance directive, POLST, or DNR if one exists (not required to enroll)
• Identity and contact details for the person who will sign if the patient cannot

A full list is in what documents you need to start hospice. Note that a DNR is not required to enroll in hospice; you can choose hospice and still have no DNR on file.

Correcting common misconceptions

"Choosing hospice is permanent." It is not. You can leave hospice and resume treatment at any time, and you can change your designated hospice once per benefit period without penalty.

"We have to give up our own doctor." In many cases the patient can keep their attending physician working alongside the hospice team. Ask the provider how they coordinate with your doctor; see can you keep your own doctor on hospice.

"It's expensive to start." The Medicare hospice benefit covers services, equipment, and medicines for the terminal illness; out-of-pocket costs are usually limited to small amounts, such as up to $5 per prescription for drugs and 5% coinsurance for inpatient respite. It does not cover room and board under Routine Home Care.

"We must wait for a hospital discharge." You do not. Anyone can call a hospice to request an evaluation, and care can begin at home, in a facility, or after a discharge.

Frequently asked questions

Does my doctor have to refer us, or can we call a hospice ourselves?

Anyone can call a hospice directly to request a free evaluation — you do not need the doctor to call first. However, a physician's certification of terminal prognosis is required before care can formally begin, so the hospice will coordinate with the treating doctor.

What if my loved one improves after enrolling?

That happens, and it is good news. If the prognosis no longer fits, the patient can be discharged (sometimes called "graduating") and can re-enroll later if the illness progresses again. See can you go back on hospice after discharge.

Can we enroll someone with dementia who can't consent?

Yes. Their authorized representative — typically a healthcare power of attorney or legal next of kin — can sign the election statement on their behalf.

Will enrolling stop all of my loved one's medications?

No. Hospice manages medications for comfort and the terminal illness; many routine medicines continue. The team reviews the full list and may stop drugs that no longer help. See does hospice stop your other medications.

Practical next steps

• Call a Medicare-certified hospice and request a free evaluation, you do not need the doctor to call first.
• Ask the treating physician to certify and share records with the hospice.
• Gather insurance and medication information and any existing directives.
• Identify who will sign if the patient cannot, and bring the power-of-attorney document.
• Compare two or three providers before signing the election statement.

Ready to begin? Compare hospices near you (or browse a state such as Texas) and ask each agency how soon they can do an evaluation and admit.