What Happens at a Hospice Evaluation?

A hospice evaluation is a free, no-obligation visit — usually by a hospice nurse — to review your loved one's illness, symptoms, and needs and to begin determining whether the prognosis fits hospice. Agreeing to an evaluation does not commit you to enrolling, and it costs nothing.

Who comes and where

An evaluation can happen wherever your loved one is: at home, in the hospital, in a nursing home, or in assisted living. A hospice nurse (sometimes with an admissions coordinator or social worker) typically conducts it. The hospice physician or medical director reviews the findings and, together with the patient's attending doctor for the first benefit period, certifies whether the person has a prognosis of six months or less if the illness runs its normal course.

What the visit covers

Expect a calm conversation and a gentle assessment, not a battery of tests. The nurse will usually:

• Review the diagnosis, medical history, and recent hospital or ER visits
• Ask about symptoms — pain, breathlessness, appetite, sleep, mood — and how daily function has changed
• Do a basic physical check and review current medications
• Ask what matters most to your loved one and family, and what the goals of care are
• Explain how hospice works: the team, the four levels of care, what's covered, and how 24/7 on-call support works
• Answer your questions and address fears or misconceptions

Having notes ready helps — dates of hospitalizations, weight changes, infections, and how function has declined. This family checklist shows what to gather.

What you'll learn

By the end, you should understand whether hospice appears appropriate, what services your loved one would receive, what (if anything) you'd pay, and what enrollment would involve. If the person has Medicare Part A, the benefit generally covers the hospice team, medications for the terminal illness, and related equipment, often with little or no out-of-pocket cost — with a possible copay of up to $5 per comfort prescription and 5% coinsurance of the Medicare-approved amount for inpatient respite care.

How to prepare so the visit is useful

A little preparation makes the evaluation go faster and gives the team a clearer picture. Before the visit, try to gather:

• A current medication list with doses, or the actual pill bottles
• A short timeline of recent decline — dates of hospital and ER visits, infections, falls, and weight changes
• Any advance directives you already have (living will, healthcare power of attorney, POLST/MOLST, DNR if one exists)
• The names and numbers of current doctors
• A written list of your questions and what matters most to your loved one

You do not need to have everything perfect. The team can work with whatever you have, and the social worker can help fill gaps later. See what documents you need to start hospice for the full list.

Questions worth asking the evaluator

An evaluation is a two-way conversation. Good questions to bring include:

• Based on what you see, does hospice appear appropriate now, or what would you watch for?
• Who would be on the care team, and how often would they visit?
• How does the 24-hour on-call line work, and who answers nights and weekends?
• What exactly is covered, and is there any cost to us?
• Can our own doctor stay involved?
• What happens if symptoms become a crisis at home?
• How do you handle our cultural or religious wishes?

How the evaluation differs by setting

An evaluation looks broadly the same wherever it happens, but the logistics shift with the location. The core conversation and assessment do not change; what changes is who else is in the room and how records flow.

In every setting the physician's certification, not the location, decides eligibility, and the evaluation itself remains free and non-binding.

A common misconception

Many families fear that calling for an evaluation “locks them in” or means “giving up.” It does not. An evaluation is information-gathering, not a commitment — you can decline to enroll, and if you do enroll you can later change hospices or leave hospice entirely. The evaluation also does not, by itself, decide eligibility; that is the physician's certification. We are not your medical provider, and this is not medical advice.

What happens after

If hospice is appropriate and you choose to proceed, enrollment can often begin quickly — sometimes the same day — starting with signing an election statement and building a plan of care. If hospice isn't the right fit yet, the team can suggest alternatives and you can request another evaluation later as the illness changes. Here's how enrollment works.

Frequently asked questions

Does an evaluation cost anything?

No. A hospice evaluation is free and carries no obligation. You can request one without a referral, and agreeing to it does not commit you to enrolling.

Does agreeing to an evaluation mean we are enrolling?

No. It is information-gathering. You can decline to enroll afterward, and even if you do enroll you can change hospices or leave hospice at any time. Election is a separate, later step.

Do we need a doctor's referral?

No. You can contact a hospice directly to request an evaluation, or ask the treating doctor for a referral. You do not need anyone's permission to ask a hospice to assess your loved one.

Who actually decides if my loved one qualifies?

The hospice physician or medical director certifies eligibility, with the attending doctor for the first benefit period. The nurse's evaluation gathers the information; the physician makes the determination. It is a medical judgment, not a family self-test.

What if hospice isn't appropriate yet?

The team can suggest other options and you can request another evaluation later as the illness progresses. Many people are evaluated more than once before the prognosis clearly fits.

What to do next

If an advanced illness is causing repeated decline, symptoms, or hospital visits, request a free hospice evaluation. You can ask the treating doctor for a referral or contact a hospice directly — you do not need a doctor's permission to ask for an assessment.

When you're ready, compare Medicare-certified hospices near you. You may also want to read who qualifies for hospice care and the family eligibility checklist.