When to Call the Hospice Team vs. Go to the Hospital

Call the hospice's 24/7 line first for almost anything: a new or worse symptom, a fall, a medicine question, or a death at home. Go to the hospital when the hospice team arranges it or tells you to. Call 911 if your loved one wants CPR and their heart or breathing stops, if someone else is hurt or in danger, or if you cannot reach the hospice and the problem cannot wait. You always have the right to go to a hospital, but Medicare may not pay for an ER visit, hospital stay, or ambulance for the terminal illness that the hospice did not arrange.

A quick decision guide

Situation	Call first	What may happen next
New or worse pain, breathlessness, agitation, or nausea	Hospice	Phone guidance, a medicine change, or a nurse visit
Symptoms the team cannot control at home	Hospice	Continuous home care, or an inpatient bed the hospice arranges
A fall, even with a possible broken bone	Hospice, if you can reach them right away	A nurse visit, or an ER trip the hospice arranges
Death at home, or you think it has happened, unless the patient wants CPR	Hospice, not 911	A nurse can come, confirm the death, and handle next steps
The patient wants CPR and the heart or breathing stops	911, then hospice	Responders attempt CPR
Someone else is hurt, a fire, or other danger	911	Emergency response to that problem
You cannot reach the hospice and it cannot wait	911, after trying the line again	Tell responders the patient is on hospice and show any DNR or POLST
The caregiver cannot go on tonight	Hospice	Extra support, or a short respite stay in a facility
Wanting treatment aimed at the terminal illness again	Hospice, to talk about stopping hospice	A signed revocation; regular Medicare coverage resumes

Why call hospice first

Medicare says a hospice nurse and doctor are on call 24 hours a day, 7 days a week. The team already knows the plan of care and your loved one's goals, and the 24/7 on-call line exists so you are never alone with a symptom. Calling 911 instead can bring an ambulance, an ER visit, and treatments your loved one did not want, and being on hospice does not by itself stop responders from attempting CPR. There is a cost reason too: Medicare tells families to contact the hospice team before getting ER, hospital, or ambulance care, or they might have to pay the entire cost.

Call the hospice team for symptoms like these

• New or worsening pain, or pain that the current medicine is not controlling
• Breathing changes: shortness of breath, noisy "rattling" breathing, or long pauses
• Agitation, confusion, or restlessness (sometimes called terminal restlessness)
• Nausea, vomiting, constipation, or trouble swallowing medicines
• Heavy bleeding or a seizure; if you cannot reach a nurse right away, call 911
• A fall, or skin breakdown
• Questions about comfort-kit medications or doses, or a medicine running low
• Oxygen or other hospice equipment that stops working
• You believe death is near or has occurred
• You are frightened or do not know what to do

For what these symptoms mean and how the team treats them, see hospice symptom management.

What the hospice can do at 2 a.m.

It can feel wrong to stay home when something alarming happens. But federal rules require hospices to keep nursing services, physician services, and drugs routinely available around the clock, and the team has these options:

• Medicine in the home. If the hospice has placed a comfort kit, the nurse can guide you through using it by phone.
• A new order. The nurse can reach the on-call hospice doctor about a new or changed medicine.
• A nurse at the door, when the phone is not enough.
• Continuous home care. During a short crisis, mostly nursing care in the home for at least 8 hours in a day and up to 24, to keep your loved one at home.
• General inpatient care. A short stay in a facility for pain or symptoms that cannot be managed at home.

When the hospital is the right place

Going on hospice does not take away your right to emergency care. A hospital can make sense when:

• The hospice sends you. The team may decide the hospital is the right place, for example for symptoms it cannot control at home. Medicare says inpatient hospital care for the terminal illness has to be arranged by the hospice, and when it is, the hospice benefit covers it.
• The problem is truly unrelated to the terminal illness. Regular Medicare, or your Medicare Advantage plan if you kept one, still covers that care, but you owe the usual deductibles, copayments, and coinsurance. But do not assume an injury counts. The hospice decides what it considers unrelated, and CMS says unrelated conditions are "exceptional and unusual." For elections starting on or after October 1, 2026, the hospice must give you a written list of what it considers unrelated and will not cover, within the first 5 days and updated within 3 days of a plan change. If you disagree, you can ask Medicare's quality-review organization (the BFCC-QIO) for immediate advocacy.
• The patient or decision-maker wants treatment aimed at the terminal illness again. That means stopping hospice, which takes a signed revocation statement. Regular Medicare coverage resumes, and hospice can be chosen again later if the patient is still eligible. See leaving hospice to resume treatment.

Even in these cases, call the hospice as soon as you can so the team can coordinate with the hospital. More detail on coverage is in can you go to the ER on hospice.

When 911 is the right first call

• The patient wants CPR and the heart or breathing stops. An on-call nurse cannot arrive in time, so agree on this plan with the hospice in advance. See does hospice require a DNR.
• Someone else is hurt or in danger, such as a caregiver who collapses, or a fire.
• You cannot reach the hospice and the problem cannot wait.

What to do after a fall

Call the hospice before you try to lift anyone. If you think a bone is broken or the head or neck is hurt, keep the person still: MedlinePlus first-aid guidance says not to move someone with an injured hip, pelvis, or upper leg, or a possible head injury, unless it is absolutely necessary. That guidance also says to call 911 for these injuries, which is right for most people. On hospice, call the hospice line first if you can reach it right away, because the nurse can come, tell you to go to the ER, or arrange the trip so it fits the plan of care and coverage. If you cannot reach anyone, call 911.

What if the hospice does not answer or the nurse is delayed?

Call again and stay on the line. If an answering service picks up, ask it to page the on-call nurse again and a supervisor. If your loved one is in severe distress and you still cannot get through, call 911, tell responders the patient is on hospice, and show any DNR or POLST form.

Federal rules require nursing services to be routinely available 24 hours a day, 7 days a week, but they set no response time. California is an exception, with a two-hour limit for a nurse to appear in person; see questions to ask about after-hours support. If you could not get help when you needed it, raise it with the hospice's administrator. You can also complain to your state survey agency, which must run a toll-free hotline for hospice complaints, or to Medicare's BFCC-QIO. See how to file a complaint about a hospice.

How an after-hours call goes

Have the medication list and any comfort kit nearby. Say that the patient is on hospice, what changed and when it started, and what medicine was given, how much, and when. Then:

1. A nurse answers or calls you back. Some hospices use an answering service that reaches the on-call nurse.
2. The nurse guides you through immediate steps, for example how to give a comfort-kit dose or reposition for easier breathing.
3. The nurse decides whether a visit is needed and sends someone if so.
4. The team escalates if necessary, arranging a higher level of care rather than a default ER trip.
5. The call is documented, so the regular team knows what happened.

If your loved one lives in a nursing home or assisted living

Facility staff may be the ones making the call, so tell them the plan. Federal rules require a nursing home to notify the hospice immediately of a significant change in the patient's condition, a need to transfer them, or a death, and the hospice stays responsible for arranging any continuous or inpatient care related to the terminal illness. The hospice must also give the facility instructions for reaching its 24-hour on-call system. Ask staff to call the hospice before sending your loved one out, and make sure any DNR or POLST is in the chart. Those federal rules do not cover assisted living, so ask both the facility and the hospice who calls whom at night. See coordinating hospice with a nursing home and hospice in assisted living.

When death happens at home

If your loved one dies at home on hospice and did not want CPR, the expected step is to call the hospice, not 911. A hospice nurse can come, confirm the death, and handle next steps. Calling 911 can bring paramedics who may attempt resuscitation unless they are shown an out-of-hospital DNR or POLST form that your state honors. Breathing can pause and start again in the last days, so call the hospice even if you are not sure. See do you call 911 when a hospice patient dies for the full walkthrough.

Frequently asked questions

Are we allowed to call 911 or go to the hospital on hospice?

Yes. Hospice does not forbid emergency care, and calling 911 does not cancel hospice. Calling the hospice first is about getting the right help fast and keeping coverage clear.

Should I call at night or wait until morning?

Call. The on-call line exists so families do not struggle alone or default to 911, and you will not get in trouble for calling "too much." Medicare pays the hospice by the day, not by the call. If you are wondering whether something can wait, that is a reason to call.

Who pays if we go to the ER without calling hospice?

You might. Medicare does not cover ER care, hospital stays, or ambulance rides unless the hospice arranged them or they are unrelated to the terminal illness and related conditions, and it warns that you might have to pay the entire cost. Tell the hospice as soon as you can. See does hospice cover ambulance rides.

If we go to the ER, do we lose our hospice benefit?

Not by itself. Hospice ends only with a signed revocation statement or a discharge by the hospice, and Medicare says no one should ask you to sign forms about stopping hospice if you did not ask for them. Choosing treatment aimed at the terminal illness does mean revoking the hospice benefit as a whole, not for one condition, and you can elect it again later if you are still eligible.

How fast will a nurse come?

It depends on the hospice and where you live. No federal rule sets a time, so ask before you need it. See questions to ask about after-hours support.

What is a comfort kit and when do I use it?

It is a small set of as-needed medications that many hospices keep in the home for symptoms like pain, breathlessness, nausea, and agitation. Contents vary, so ask what is in yours. Use it under the nurse's guidance, and call the line before giving a dose if you are unsure.

Can hospice arrange a hospital-level bed without the ER?

Usually, yes. Federal rules require short-term inpatient care to be available for pain control and symptom management, in a hospice's own inpatient unit or a Medicare-certified hospital or skilled nursing facility. It is a planned stay, different from an unplanned ER visit.

Practical next steps

• Post the hospice's 24/7 number on the fridge and save it in every caregiver's phone.
• Agree as a family that hospice is the first call for symptoms and at the time of death.
• If your loved one wants CPR, agree with the hospice on what to do if the heart stops, and tell everyone in the home.
• Keep the comfort kit and medication list handy so the nurse can guide you by phone.
• Ask your hospice how fast a nurse can reach the home at night.

After-hours responsiveness varies between providers. If you are still choosing, compare hospices near you and ask each one how they handle nighttime emergencies.