For HealthCare Providers

When to Refer

Knowing when to refer a patient for a hospice evaluation can be difficult. Instead of asking yourself if your patient has a prognosis of six months or less, consider asking yourself the “surprise” question: Would I be surprised if I saw my patient’s name in the obituary column of the local newspaper in the next year?

While coverage for hospice services is available through Medicare, Medicaid and most insurances, it is significantly underused by patients across the country, including in Minnesota. Because many patients enter hospice care late in the course of their life-limiting illness they and their families often report they wished they had utilized hospice sooner.

elderly couple and a doctor

Some signs that may indicate eligibility for hospice care:

  • Increased or uncontrolled pain
  • Decline in ability to perform activities of daily living (ADLs)
  • Frequent infections
  • Frequent hospitalizations or ER visits
  • Increased weakness and/or fatigue
  • Increased skin problems
  • Withdrawal, confusion, bedbound
  • Progressive decline, in spite of curative medical therapies
  • Patient verbalizes “I am ready to die”

Patients may have one or more of the following diagnoses to qualify for hospice:

  • Alzheimer’s disease and advanced dementia
  • Heart diseases
  • Liver disease
  • Renal disease
  • Cancer
  • Pulmonary diseases
  • COPD
  • ALS
  • Parkinson’s

Having the Conversation with Your Patient

How do I start the conversation about hospice?

Talking about hospice care does not mean there is nothing else you can do for the patient. It doesn’t mean there is no hope. Hospice is not giving up but changing the focus of care from cure to comfort.

Consider that by talking about hospice you are giving your patients information about all the options available. You are helping them choose what might be best and when. Your patients trust you. Your conversation about hospice care will go a long way in giving them confidence to learn more.

When should I start the conversation?

Many events can trigger a conversation about hospice care, including:

  • You determine a patient has a serious illness
  • Your patient has experienced repeated trips to the emergency room or hospitalizations
  • You notice a steady or significant decline in your patient’s condition, or the patient or a family member has indicated the same
  • Your patient or a family member is discouraged by, tired from, or requests no further treatment
  • Your patient expresses a desire to be comfortable, stay where they are, get support for his/ her family, or is concerned about rising medical bills resulting from treatment
  • Your patient or a family member asks about hospice care

Hospice of Douglas County worked with Stratis Health to help health care providers identify patients who could most benefit from a hospice referral, and to recognize opportunities to encourage patient/provider conversations about hospice or other end of life care earlier in a patient’s course of treatment.

Hospice Provider Resource
Hospice Provider Brochure

Hospice Presentations

Learning about end-of-life issues and the ways that you can support the hospice effort in our community can bring fulfillment to individuals and groups alike.

If your organization or group would like to learn more about hospice and the programs and services we offer we would welcome the opportunity to meet with you.

Our informational programs are designed for businesses, schools, faith organizations as well as others. We will be happy to share our message of hope and caring with you.

Contact Patty Marriott at Hospice of Douglas County for more information:
Patty Marriott, BSN CHPN, Hospice Supervisor

Woman speaking at a lecturn