Moving a Loved One Into Hospice From the Hospital

To move a loved one from the hospital onto hospice, ask the unit for the discharge planner or case manager, choose any Medicare-certified hospice (not just one the hospital suggests), sign the hospice election, and arrange transport to home or a facility. With coordination, this transition can often happen the same day or the next, so symptom-focused comfort care begins quickly.

Step 1: Start the conversation early

If hospital treatment is no longer helping or your loved one wants to stop aggressive care, raise hospice with the medical team. Ask the doctor a direct question such as, "Is it time to focus on comfort?" The hospital's case manager / discharge planner coordinates the logistics, but the choice of hospice is yours. Under Medicare's hospital rules, a discharge planning evaluation must consider whether the patient is likely to need services after leaving, hospice care included. If no one has offered one, you, your loved one, or their doctor can ask for it.

Step 2: Choose your hospice, not just the default

Hospitals often have hospices they routinely refer to, but you have the right to pick any Medicare-certified hospice that serves your area. It is worth a few minutes to compare hospices near you on quality and family-survey scores before you decide, even under time pressure. You can also change your designated hospice later, once per benefit period, with no penalty.

Step 3: The hospice evaluates and admits

The hospice sends a nurse to assess your loved one, often right in the hospital room. The hospice physician (with the attending physician) certifies the terminal prognosis, which is a clinical judgment of six months or less if the illness runs its normal course, not a family checklist. You then sign the election statement and consent forms. The election takes effect on the date you choose, which can't be earlier than the day you sign. Many families set it for the day of discharge. For elections starting on or after October 1, 2026, Medicare requires every hospice to give you an election statement addendum in writing within the first 5 days after the election takes effect. Before this change, you received it only if you asked for it. The addendum lists the conditions, items, services and drugs the hospice considers unrelated to the terminal illness, which the hospice won't cover. Signing it only confirms that you received it. It doesn't mean you agree. Gather the items in our guide on documents you need to start hospice to speed this up.

Step 4: Decide where care will happen

• Home: most common. The hospice arranges a hospital bed, oxygen, and other equipment, often delivered the same day, plus comfort medications.
• Nursing home or assisted living: hospice can follow your loved one there; note that the hospice benefit does not cover the facility room and board under Routine Home Care.
• Inpatient hospice unit: if symptoms are severe, a short General Inpatient stay may be appropriate until they stabilize.

Step 5: Arrange transport

The case manager helps schedule transport home or to a facility. Once hospice has started, Medicare.gov says the benefit does not cover an ambulance ride unless the hospice team arranges it (or the ride is unrelated to the terminal illness). So if your loved one needs an ambulance, ask the hospice and the case manager to settle who books it and who pays before discharge day. A ride by car or wheelchair van usually falls to the family. See does hospice cover ambulance rides. The hospice should have equipment and medications in place before or at the time your loved one arrives.

Step 6: Prepare the home before arrival

If care will happen at home, a little preparation makes the first night far smoother. Clear a path for a hospital bed and any equipment, decide which room will become the care space (often a main-floor room near a bathroom), and make sure there is a working phone with the hospice's 24/7 number saved. The hospice typically delivers a bed, oxygen if needed, and a small kit of comfort medications — sometimes called a "comfort pack" or "emergency kit" — to keep on hand for symptoms that arise after hours. Ask the team how to store and use it, and who to call before using anything. Knowing the equipment and medicines are in place before your loved one arrives prevents the common scramble of a discharge that outruns the supplies.

Can hospice care happen in the hospital itself?

Sometimes, but only for a short stay with a specific purpose. Hospice general inpatient care treats pain and symptoms that can't be managed at home. It can be given in a hospice inpatient unit, or in a Medicare-certified hospital or nursing facility that meets Medicare's staffing and patient-area standards and works with the hospice. When symptoms are under control, care moves to home or to the facility where your loved one lives. A patient who is comfortable and only waiting to leave does not qualify for inpatient hospice care. See what is general inpatient hospice care.

Can it happen the same day?

Often, yes. Hospices are set up for rapid admissions, and many can complete an evaluation and admission within hours when a patient is ready to leave the hospital. Our guide on same-day hospice admission explains what makes a quick transition possible and what can slow it down (waiting on equipment, transport, or certification).

What can speed up or slow down the transfer

Speeds it up	Slows it down
You've already chosen a hospice	Still comparing providers at discharge
Documents and ID gathered in advance	Missing paperwork or decision-maker unavailable
Home is ready for a bed and equipment	Equipment or transport not yet arranged
Decision-maker present to sign	Family disagreement about the plan
Hospice already serves the facility	Certification still being completed

What to confirm before you leave the hospital

• The 24/7 hospice on-call number, and that you call hospice, not 911, in a crisis at home.
• That comfort medications and equipment will arrive in time.
• Who the first hospice contact will be after discharge.
• A clear medication plan, so hospital and home orders do not conflict.

The misconception to correct

Two assumptions trip families up at discharge. The first is that you must use whichever hospice the hospital names; you do not — the choice is yours, and you can compare options even under time pressure, and switch later if needed. The second is that calling 911 is the right move if a crisis happens once your loved one is home on hospice. It is not. At home on hospice, you call the hospice's 24/7 line, not 911, because the hospice team manages crises and a 911 call can trigger interventions that conflict with the comfort-care plan. Make sure everyone in the household knows this before discharge.

How the bills change after you elect hospice

Electing the Medicare Hospice Benefit shifts how care for the terminal illness is paid. From the election date forward, the hospice covers team visits, comfort medications, and equipment for the terminal diagnosis, with no deductible and only two small cost-shares: a drug copay of up to $5 per prescription and a 5% coinsurance of the Medicare-approved amount for any inpatient respite stay. What hospice does not pay is room and board under Routine Home Care — so if your loved one is going to a nursing home or assisted living, that residence bill continues as before. One detail that surprises families: once the election takes effect, you give up regular Medicare payment for care related to the terminal illness from anyone other than the hospice (or the attending doctor you named). That includes a Medicare-covered skilled nursing facility stay for the same condition. Ask the case manager to walk through costs before you sign. Care unrelated to the terminal illness can still be billed to regular Medicare. The addendum described in Step 3 is where the hospice puts in writing what it considers unrelated.

Frequently asked questions

Do I have to use the hospice the hospital recommends?

No. You may choose any Medicare-certified hospice that serves your area. Hospitals often have a default referral, but the decision is yours, and you can take a few minutes to compare quality and family-survey scores first.

Who pays for the ride home?

It varies. Routine non-emergency transport home is not always covered, so confirm with the case manager who pays before discharge day. The hospice itself covers care, medications, and equipment for the terminal illness, but the transport home is a separate question worth settling in advance.

What if my loved one needs intense symptom control on arrival?

If symptoms are severe, the team can begin at a higher level of care — a short General Inpatient (GIP) stay — until things stabilize, then step down to home care. Discuss this with the hospice during the evaluation so the right setting is arranged from the start.

Can the hospice admit my loved one over a weekend or holiday?

Often, yes, but ask each hospice, because admission hours vary. Medicare does require every hospice to have nursing services, physician services and drugs available 24 hours a day, 7 days a week. A weekend or holiday discharge can go ahead. Confirm the equipment and transport ahead of time to avoid delays.

Can my loved one go back to the hospital after starting hospice?

Yes. You can revoke the hospice election at any time, and regular Medicare coverage of treatment resumes. You can elect hospice again later if your loved one is still eligible. While on hospice, call the hospice before going to the hospital. The hospice may be able to manage the problem, or arrange inpatient care itself. See can you go to the ER or be hospitalized on hospice.

What documents do we need ready?

Have the patient's ID and insurance/Medicare information, any advance directive or POLST, the medication list, and the contact details for the healthcare decision-maker. Our guide on documents you need to start hospice covers the full list.

What happens next

Once home, the hospice completes its initial assessments and finalizes the plan of care. Our guides on day-one intake and how to enroll a loved one in hospice cover what to expect.

What to do next

Ask to speak with the hospital case manager today, name the hospice you have chosen, and request that the hospice evaluate your loved one before discharge so care continues without a gap. Confirm the 24/7 number, the equipment delivery, and the transport plan before you leave — those three details prevent most first-day problems.