For patients on Hospice at home already that have had some acute event occur that prompted return to the hospital is not common but does occur. The Hospice vendor will send a nurse to meet with the patient and family in the Emergency department or the next day at the hospital for the patient to 'revoke' hospice service if that is what the patient elects to do, and receive more aggressive care. Then at time of discharge, if the patient and family want to resume with hospice care, they can sign up for that service once again.

New referrals to hospice may occur while at a hospital as a disease state has reached an advanced stage and now patients want to accept that service. The hospice vendor will come to the hospital to meet with the patient and family and discuss their services. The patient has the option to talk with more than one hospice agency and select the one that can best meet their needs. The hospice will certify the patient and papers can be signed at the hospital.

Unless you are very familiar with the various hospice agencies in your area, consider more than one. The hospital as well as the hospice agency will want a safe discharge, so any equipment, supplies, or oxygen that might be needed will be delivered prior to the patient being discharged.

If a patient is too critically ill to survive transportation to a different location, it is advised the patient accept hospice there at the hospital for the few remaining hours of life. The hospice team will visit the patient there and support the family while the patient is cared for at the hospital with hospice level care.

Representing the patient's choices is such an important responsibility. Sometimes the patient can no longer communicate what they want. The hospital physicians have responsibility to inform patients and families as changes occur in their health so if patients want to change their decisions they can do so with the most current information. Circumstances change, trajectory of an illness or disease state may change, thus the patients hopes may change.

Patients may have instructed their families that they did not want to wind up on machines but circumstances were such that these machines are now in use. The family may wish to designate a time when the machines can be removed compassionately with support provided and symptoms managed to alleviate suffering. If the course of the illness has become clear and cure is not available, care and compassion are always to be provided, and comfort focused hospice care can be provided during those times.