What Happens After You Choose Hospice: A Step-by-Step Onboarding Guide (Part 1)
Choosing hospice care is a pivotal moment in the life of a patient and their family. It marks a shift from focusing on cure to prioritizing comfort, dignity, and quality of life. But what exactly happens after you make that decision?
This expanded step-by-step guide is designed to take the mystery and fear out of the hospice onboarding process. Whether care will take place at home, in a nursing facility, or in a hospital setting, hospice brings a full team of support services to ease the burdens of end-of-life care.
In this two-part onboarding guide we will explore how hospice care begins, who is involved, what services are provided, and how patients and families are supported through every stage of the journey.
Part 1: The First Days of Hospice Care
Life changes or changes in the status of life can be unsettling for some, but hospice is designed to make both the patients and their families as comfortable as possible. The onboarding process includes the hospice provider working with the patients and caregivers to build and design a care plan that includes what to expect and how comfort will be provided.
Step 1: The Hospice Admission Appointment
Once a patient’s physician has determined the life expectancy is six months or less, a patient is now qualified for hospice care. Hospice admissions can happen on the same day that the physician’s referral is sent. The hospice provider will receive a referral and coordinate with the patient and family for scheduling admission.
What to Expect During the Visit:
A hospice nurse or admissions coordinator will meet with the patient and family in the home, hospital, or care facility, and will go through the following:
- Review of hospice philosophy, explanation of services and benefits, and gathering of necessary paperwork.
- Get informed consents and patient rights documents are reviewed and signed.
- Discuss what matters most to the patient – pain control, family time, legacy planning, or spiritual peace.
Why It Matters:
This meeting sets the tone for the hospice relationship. It ensures the family understands that hospice is about living fully in the time that remains – not about giving up. It also gives patients a chance to express fears, goals, and hopes.
Caregiver Tip: Bring any existing paperwork (advance directives, medication lists, insurance cards) to the visit to help streamline onboarding.
Step 2: Interdisciplinary Team (IDT) Assignment
Shortly after admission, the patient is assigned a full care team. This is a key feature of hospice: care is delivered not just by one provider, but by an interdisciplinary team working together to address all aspects of the patient’s needs.
Your Hospice Team Includes:
- RN Case Manager: Oversees clinical care, manages symptoms, and educates caregivers.
- Hospice Physician: Partners with the RN to approve medications and treatment plans.
- Hospice Aide: Provides help with personal care, hygiene, and comfort measures.
- Social Worker: Supports emotional, financial, and legal needs.
- Chaplain: Offers spiritual and existential care based on patient preferences.
- Volunteers: Provide companionship and respite, if desired.
Team Introduction Timeline:
- The RN often introduces themselves on the day of admission or the next.
- Other team members will reach out within the first 5 to 7 days.
- The schedule is based on urgency of need and patient preference.
Caregiver Insight: Each team member brings a unique form of support, helping reduce the burden on families and creating a web of compassionate care.
Step 3: Initial Nursing Assessment
Once assigned, the RN case manager conducts a thorough clinical assessment to establish the patient’s baseline condition.
This Assessment Includes:
- Vital signs and physical examination
- Pain, shortness of breath, nausea, or fatigue evaluation
- Skin integrity, mobility, nutrition, and hydration check
- Mental status and mood observation
- Safety and fall risk assessment
The Outcome:
- A personalized care plan is created, focusing on comfort and dignity.
- Pain and symptom medications are prescribed or adjusted.
- Education begins for caregivers on what to expect and how to assist. This education will continue as the needs of the patient changes, but this is where the first step of that journey begins.
Step 4: Equipment Needs Assessment and Delivery
Comfort at home often depends on having the right medical equipment. The RN evaluates what’s needed to ensure the best levels of safety and symptom control for your loved one.
Common Equipment Provided:
- Hospital bed with adjustable settings
- Oxygen concentrator or tank
- Bedside commode or urinal
- Shower chair or transfer bench
- Wheelchair or walker
- Pressure-relieving mattress
Delivery Timeline:
- Equipment is ordered by the nurse and delivered by a medical supply company, often the same day or within 24 hours.
- Technicians set up the items and explain how to use them safely.
Step 5: Medication Review and Orders
Comfort-focused care often involves simplifying the patient’s medication regimen. Hospice clinicians review every medication the patient is taking to identify what should continue, change, or stop to provide your loved one with the best levels of comfort possible.
Goals of Medication Review:
- Eliminate medications that no longer contribute to quality of life (e.g., cholesterol meds)
- Add medications for pain, anxiety, restlessness, nausea, and respiratory symptoms
- Ensure compatibility and ease of administration (e.g., switching to liquids or patches)
Comfort Kit:
Most hospices provide a “comfort kit” with pre-authorized medications that can be given for common symptoms.
A comfort kit might include:
- Morphine or oxycodone for pain or breathlessness
- Lorazepam for anxiety or restlessness
- Hyoscyamine or atropine drops for respiratory secretions
- Acetaminophen for fever or discomfort
Delivery:
Hospice pharmacies deliver medications directly to the home, often within mere hours.
Step 6: Scheduling Nursing and Aide Visits
Visit frequency is determined based on the patient’s condition and the availability of caregivers.
Typical Schedule:
- RN Visits: 1 to 3 times per week, or more during symptom changes
- Hospice Aide: Up to 5 days per week for bathing, grooming, and skin care
- Emergency Visits: 24/7 access if the patient’s condition changes suddenly
Customized Care: Hospice care is not “one-size-fits-all.” The visit schedule is reviewed weekly and adjusted as needed.
Family Insight: Many caregivers find hospice aide visits essential, as they offer hands-on help and give family members a chance to rest.
Beginning the process of providing hospice care for a loved one can be a trying experience for everyone involved. As the ultimate goal of hospice is to provide dignity and comfort, your caregivers know that this begins with the very first step. New situations can be scary and unsettling, but the onboarding process is crucial to help your team know how to best care for your loved one.
In the next part of this series, we will focus on the social, spiritual, and ongoing support that hospice provides to both patients and their families along with the patient’s physical needs.