This article is for informational purposes only and does not constitute medical, legal, or financial advice. Always consult with qualified professionals regarding your specific situation.

How to Enroll in Hospice — The Process and the Conversation with the Doctor

Once you've decided that hospice is right, or you're thinking seriously about it, you need to know how to actually make it happen. The process isn't complicated, but it involves several steps and it requires having a conversation with your parent's doctor that might be one of the hardest conversations you have. You're asking your parent's doctor to stop treating the disease and start focusing on comfort. You're asking them to acknowledge what they might have been fighting against for months or years. You're asking them to change their approach.

This conversation is easier if you understand what's going to be asked, what happens after, and what the timeline looks like. Going into it prepared helps you stay focused on what matters, which is making sure your parent gets the care they need now.

Starting the Conversation

The conversation about hospice starts with your parent's doctor, but it often starts with you. The doctor might bring it up, but if they haven't, you might need to. You can ask directly: given where we are with treatment, is it time to think about hospice? Or you can ask the softer version: what would you do if this was your parent? Do you think aggressive treatment is helping at this point?

The goal isn't to pressure the doctor. The goal is to create the opening for an honest conversation. Some doctors are reluctant to bring up hospice because they feel like it's giving up or they worry it will upset the patient. Some doctors just don't think about it unless prompted. Some doctors are waiting for you or your parent to initiate.

You might frame it as a question: I've been reading about hospice. I wonder if that would be something worth considering at this point. Or you might ask directly: what's your realistic assessment of how much time Mom has? Based on that, what would you recommend in terms of care?

The key is that you're not attacking the doctor. You're not saying they've failed. You're acknowledging that the situation has changed, and you want to make sure you're giving your parent the best care available given where they actually are. Good doctors will hear that and will work with you.

What the Doctor Asks

Once you've opened the conversation about hospice, your parent's doctor needs to establish a few things. First, they need to confirm that the disease is terminal and that life expectancy is likely less than six months. This is partly a medical determination (what does the disease look like, how is it progressing) and partly a clinical judgment (based on everything they know, how much time does this person have).

The doctor will ask about your parent's understanding of their illness. Do they know they're dying? Do they accept it? This affects how the conversation moves forward. If your parent doesn't understand their prognosis, the doctor might need to explain it before moving to hospice. Some people need time with that information before they're ready to make decisions about hospice.

The doctor will ask what your parent wants. Not in abstract terms, but specifically. If we stop treatment aimed at cure, and focus instead on comfort, would that feel right to you? What matters to you about how you spend your remaining time? The answer shapes what hospice looks like. If your parent wants to be at home, that's one kind of hospice. If they want to be in a facility with more staff support, that's different.

The doctor will ask about pain and symptom management. Are there symptoms that aren't being controlled? What's not working? This helps the hospice team know what to focus on from the beginning. If your parent is in significant pain, the hospice team needs to know that immediately.

The doctor will ask if your parent has a healthcare proxy or power of attorney designated. Someone who can make medical decisions if your parent becomes unable to. This needs to be clear before hospice starts.

What Happens After

Once the decision is made to pursue hospice, your doctor will write what's called a hospice referral or prescription. This document goes to the hospice agency you've chosen (or that your doctor recommends). It includes your parent's diagnosis, prognosis, current medications, symptoms being managed, any other relevant medical information.

The hospice agency receives the referral and reaches out to you to schedule an initial visit. Usually within a day or two, a hospice nurse comes to your parent's home. This is called the intake visit. The nurse does a full assessment. They talk to your parent about symptoms, goals, preferences. They look at the home and think about what equipment might be needed. They establish what your parent's priorities are.

During the intake, the hospice team explains how they work. How often nurses will visit. How you can reach someone if there's a problem. What to expect. What medications they'll use for pain and symptom management. It's a lot of information, and it's okay if you don't absorb it all. You can ask questions later.

The hospice team will ask about your parent's values and preferences. Do they want to be resuscitated if their heart stops? Do they want to die at home? What would feel like a good death to them? These aren't morbid questions. They're practical questions that help shape the care. If your parent says they want to die at home and be kept comfortable, that's the goal. Everything gets organized around that.

Depending on your parent's situation, various team members get involved immediately or over time. A nurse visits regularly. A social worker reaches out to coordinate logistical things and offer support. A chaplain or spiritual counselor might be involved. An aide helps with personal care.

The Timeline

How long the process takes depends on several things. If your parent's doctor is responsive and the decision is clear, a referral can be written and your parent can be on hospice within a day or two. If there's more complexity, it might take a few days.

Once the referral is submitted, the hospice agency is required to do the intake assessment within a specific timeframe (usually within a few days, but it varies by regulations in your state and by the hospice agency). Once the assessment is complete and your parent officially enrolls, the team springs into action.

The timeline for medications is important. If your parent is in significant pain and current medications aren't working, hospice can often change medications more quickly than outpatient doctors can. This is one of the benefits of hospice—it's focused on symptom management and can be more responsive.

The timeline for feeling relief varies. Some people feel better almost immediately because their pain is finally controlled. Some people take a few days to adjust to new medications. Some people feel worse before they feel better as drugs are adjusted. Hospice teams are experienced with this and can help manage the transition.

The Practical Questions

Before or during the intake, you'll need to figure out some practical things. Is your parent staying at home? Is your parent going to a hospice facility? This affects what happens next. Hospice can be provided at home, in a hospital, in a nursing home, or in a dedicated hospice facility. Most often it's at home, but not always.

If it's at home, you need to think about living situation. Is there someone there during the day? At night? If your parent is alone all day, the hospice team needs to know that so they can plan visits accordingly. If you're working, they need to understand your availability.

You need to think about equipment. Hospital beds, oxygen, commodes, wheelchairs—what does your parent need? The hospice team will provide most of this, but you need to have space for it. Is the bedroom on the first floor or second floor? Can you fit a hospital bed? Does the bathroom have a shower or tub?

You need to think about medications. Hospice will provide pain medications and symptom management medications. You need to understand how to give them, what to watch for, what to do if something changes.

You'll need to think about family. Who's going to be involved in care? Who can be there during the day? Who might be there at night? The hospice team needs to know who they're working with.

The Emotional Part

The practical process is straightforward. You call your doctor, you have a conversation, you get a referral, the hospice team does the intake, your parent is on hospice. But the emotional process is much harder. You're enrolling your parent in a service that's organized around the fact that they're dying. You're stopping treatment. You're saying, out loud, that cure isn't happening. That takes something.

It's okay to be sad about this. It's okay to feel like you're giving up, even though you're not. It's okay to be relieved that there's a way to make your parent more comfortable. All of those feelings can exist at the same time.

The conversation with the doctor is a conversation about reality. Your parent is dying. Acknowledging that isn't cruelty. It's clarity. And clarity lets you make decisions that honor what's actually happening instead of clinging to what you wish was happening.

Once your parent is on hospice, the focus shifts. No more hoping for cure. No more appointments aimed at treatment. Just the work of making sure they're comfortable, that they're not alone, that they have what they need. That's actually an easier focus in some ways. It's clearer. It's gentler. It's about love instead of fighting.

How To Help Your Elders is an informational resource for families working through aging and elder care. We are not medical professionals, attorneys, or financial advisors. The information provided here is for educational purposes and should not replace professional consultation. Every family's situation is unique, and rules, costs, and availability vary by location and circumstance.