The doctor says the hospice referral has been sent. You may hear that as, “Hospice is coming.” Those are not yet the same thing.
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A referral gives a hospice information to review. It does not tell you that the hospice accepted the referral, that Medicare eligibility has been certified, that the election statement has been signed or that the first visit is on the schedule.
You can follow this process without learning every rule. Keep one sheet of paper beside you. Write down the name of each person, what that person said would happen next and who owns the next call.
Start with the place that sent the referral
Ask the doctor’s office, hospital or clinic for the name of the hospice that received the referral. Get its main number. Ask when the referral was transmitted and whether the hospice confirmed receipt.
Then ask what was sent. A hospice may need medical records and information from a physician before it can complete its review. You do not have to decide whether the record proves eligibility. You do need to know whether the receiving hospice says anything is missing.
If someone tells you, “They have everything,” ask for the name or department at the hospice that confirmed it. That gives you a place to begin if no one calls.
Call the hospice and locate the referral
When you reach the hospice, say plainly: “A referral was sent for my mother. Can you see it in your system?”
If the answer is yes, ask:
Who is reviewing it? Is any record, order or physician response still needed? Who is contacting the physician for that item? Who will call you with the decision? What number should you use if that call does not come?
If the answer is no, call the sender again while you still have the hospice’s correct fax number or electronic destination in front of you. Ask the sender to retransmit the referral and request confirmation. Do not let “sent” and “received” remain the same word in your notes.
Separate acceptance from enrollment
A hospice may tell you that it can evaluate the referral, that the person appears eligible or that it is ready to admit. Ask which one it means.
Under the Medicare hospice benefit, eligibility involves physician certification and the person or representative electing hospice care. The federal hospice rule at 42 CFR 418.24 requires an election statement naming the hospice, identifying the chosen attending physician and stating when the election takes effect. Medicare explains that the election statement must be completed before hospice services begin.
Before anyone arrives with forms, ask who is expected to sign. If a representative will sign, ask what document the hospice needs to verify that authority. Put that document where you can reach it. Do not wait until a worker is standing in the living room to begin looking for it.
Ask what the admission visit will accomplish
“Admission” can sound like one complete event. In the house, it may contain several pieces: reviewing the election, obtaining signatures, completing an initial nursing assessment, checking the medicines and equipment already present, discussing immediate needs and beginning the written plan of care.
Ask who is coming and whether that person can complete the enrollment. Ask for an arrival window, the number the worker will call from and what should be ready at the house.
A useful stack may include identification, insurance information, current medication containers or a medication list, physician contact information, advance directive documents and the name and number of the family member who will usually answer hospice calls. The hospice should tell you what it specifically requires.
The federal rule at 42 CFR 418.54 requires a hospice registered nurse to complete the initial assessment within forty-eight hours after the hospice election is complete, unless the physician, patient or representative asks for it sooner. That rule does not tell you the exact hour someone will arrive. Ask the hospice to put the actual visit window on the schedule.
Mark the moment responsibility changes
The election statement has an effective day. Ask the admission worker to point to it before you sign. Then ask, “From this point forward, what do we call hospice about before calling or arranging another provider?”
Medicare says that choosing hospice changes how Medicare pays for care connected to the terminal illness and related conditions. The election paperwork should explain the hospice’s coverage responsibility, cost sharing and your right to request a written addendum identifying items, services or drugs the hospice considers unrelated and therefore not covered by the hospice.
You do not need to settle every possible coverage question during admission. You do need the hospice’s procedure for getting an answer before you arrange outside care. Write that procedure beside the on-call number.
Turn the assessment into a working first plan
The federal rule at 42 CFR 418.56 requires an individualized written plan of care. It must identify the services needed and their scope and frequency. The hospice team prepares it with the attending physician, and with the patient, representative and primary caregiver when they wish to participate.
Ask what has been placed in the first plan, not only what the hospice offers in general. Go item by item:
When is the next nursing visit? Has an aide visit been ordered, and if so, when will scheduling call? Are social work, spiritual support or volunteer services being requested? Is any equipment or supply order being placed? Who is arranging each delivery? Which medicine questions are still waiting for review? What work remains with you between visits?
If the answer is “someone will call,” write down which department will call and by what point you should call back. A service is not installed in the house merely because it appears on a brochure.
Do not let the admission worker leave without the call path
Before the visit ends, place the hospice’s main and after-hours numbers where you can find them in dim light. Ask whether both numbers reach the same line. Ask what information the answering service will request and how a nurse calls back.
Also get the name of the nurse coordinating the plan, even if that nurse was not the person who completed admission. Ask which office handles scheduling, supplies and records. You are building a small map of the service you have just started.
The National Institute on Aging notes that home hospice usually does not place a worker in the house around the clock. Family and friends commonly provide much of the day-to-day care, while hospice staff remain available by phone and make planned visits. That is why the first schedule matters. It shows what has actually been arranged and what hours still belong to the household.
If the process stops
If the referral cannot be found, return to the sender. If the hospice says records are missing, ask which records and who requested them. If the hospice accepted the referral but no admission is scheduled, ask for the admission supervisor. If enrollment is complete but the promised first services do not appear, call the nurse coordinating the plan and ask what the written plan currently says.
Keep your notes factual: the time of the call, the person reached, the missing step and the promised response. Family Caregiver Alliance advises keeping care information organized and using one family contact when possible. A single call record helps you do both.
If you cannot resolve a concern with the hospice, Missouri Department of Health and Senior Services oversees hospice programs and investigates complaints about care. The state contact path and other West St. Louis County starting points are collected on Local Help for Hospice Families.
The process is complete when you can name what happens next
You do not need to feel settled before the admission worker leaves. You need a few concrete things: confirmation that the hospice election is effective, the first written plan, the next visit, any pending delivery, the call number and the name of the person coordinating care.
A referral is the opening handoff. Hospice has actually started when responsibility has been accepted, the required papers are complete and the first pieces of the plan have been placed on a real schedule.
This guide is based on Medicare’s hospice benefit materials, the federal hospice Conditions of Participation, National Institute on Aging caregiver guidance, Missouri Department of Health and Senior Services oversight information and national family-caregiver guidance. The source trail is maintained on the site’s Sources page.