💛 You just found out. Start here.
When someone you love has a terminal illness, it doesn't come with instructions. This page walks you through the journey step by step — from understanding what hospice is, to caregiving at home, to what happens after. Scroll at your own pace, or use the timeline above to jump ahead.
Every guide below is grounded in the same evidence that clinicians use, written in language that doesn't require a medical degree.
START HERE
Where are you right now?
- What hospice is (and what it is not)
- The 4 levels of hospice care
- Your hospice team and their roles
- What Medicare covers at $0 cost
- How to qualify and who can refer
- Your rights as a hospice family
Your Rights as a Hospice Family
You have more power than you think. Here's what you can ask for, what's covered, and what to do if things aren't working.
What Medicare Covers
- Doctor and nurse visits
- All medications for the terminal illness
- Medical equipment (hospital bed, wheelchair, oxygen)
- Medical supplies (bandages, catheters, gloves)
- Hospice aide and homemaker services
- Physical, occupational, and speech therapy
- Social worker services
- Dietary and spiritual counseling
- Short-term inpatient care for symptom crises
- Respite care (up to 5 days so you can rest)
- 13 months of grief/bereavement support after death
Your cost: $0 for most services. Up to 5% copay for inpatient respite care.
Source: Medicare.gov
You Can Change Providers
- You can fire your hospice and transfer to another provider at any time
- You can request a different nurse, aide, or social worker
- You can change hospice providers once per benefit period
- The transfer must happen in a timely manner — they cannot delay it
- Equipment, medications, and care continue without interruption
- Even in a nursing home, you choose your hospice — not the facility
To switch: call your current hospice and request a transfer form. Your new hospice will handle the rest.
Source: Compassus
You Can Always Ask For
- A family meeting — with the full hospice team to discuss the plan of care
- Continuous care — a nurse at the bedside up to 24 hours during a crisis
- Respite care — 5 days in a facility so you can sleep, travel, or rest
- Chaplain or social worker — even if you haven't been assigned one, you can request visits
- To see the plan of care — it's your right to know the plan and to disagree with it
- A different medication approach — if something isn't working, say so
- To leave hospice — you can revoke hospice at any time and return to curative care
You are the decision-maker. The team works for you.
If Something Is Wrong
- Talk to the hospice patient advocate or administrator first
- Call 1-800-MEDICARE (1-800-633-4227) to file a complaint
- Contact your state health department's hospice licensing division
- Request a copy of the Patient Bill of Rights — every hospice is required to give you one
You deserve quality care. Advocating for your loved one is not being difficult — it's being a good caregiver.
Source: Medicare Hospice Benefits (CMS)
- What advance directives are
- Living will explained
- Healthcare power of attorney
- POLST / MOLST forms
- DNR in plain language
- How to start the conversation
Advance Directives — Planning Ahead
The legal documents that make sure your loved one's wishes are honored — even when they can no longer speak for themselves.
What Are Advance Directives?
- Living Will — A legal document stating what medical treatments someone does or doesn't want
- Healthcare Power of Attorney (DPOA) — Names a person to make medical decisions when the patient can't
- POLST/MOLST — A physician-signed medical order for life-sustaining treatment
- DNR (Do Not Resuscitate) — A medical order instructing not to perform CPR
These documents work together. Having all of them gives the clearest picture of your loved one's wishes.
When to Have the Conversation
- Now. The best time is before a crisis — not during one
- While your loved one can still speak clearly and make decisions
- Before a hospitalization or surgery, if possible
- When starting hospice — the social worker can help facilitate this
- It's never "too early" — and it's rarely too late
This conversation is a gift to your family. It removes the burden of guessing.
How to Get Them Done
- Ask your hospice social worker — they do this regularly and can guide you
- Use free state-specific forms from Five Wishes or PREPARE
- Most states require two witnesses and/or notarization
- Give copies to: the healthcare proxy, the doctor, the hospital, and the hospice
- Keep the original somewhere accessible — not in a safe deposit box
You do not need a lawyer for most advance directives.
Source: National Institute on Aging
How to Start the Conversation
- "I want to make sure we honor what you want — can we talk about it?"
- "If you couldn't speak for yourself, what would matter most to you?"
- "What would a good day look like? What would you want to avoid?"
- "Who do you trust most to make decisions for you?"
It doesn't have to be one big conversation. It can happen over several small ones.
- Setting up the home for comfort
- Bathing, turning, and skin care
- Managing eating and hydration changes
- What to do when symptoms change
- When to call hospice vs. 911
- Daily caregiver checklist
Daily Caregiver Checklist
A simple daily tracker to help you remember what happened, what was given, and what to tell the nurse. Print it out and keep it by the bedside.
💡 Tip: Print several copies and keep them by the bedside with a pen. When the nurse calls or visits, you'll have everything in one place.
When to Call — Hospice vs. 911
Knowing who to call — and who NOT to call — can prevent unwanted interventions and get your loved one the right help fast.
- Uncontrolled pain — medications aren't working, or pain is getting worse
- New or worsening symptoms — fever, vomiting, bleeding, new confusion
- Breathing changes — shortness of breath, noisy breathing, long pauses
- Falls — even if they seem OK, the nurse needs to assess
- Medication questions — "Can I give another dose?" "It's not working" "I spilled it"
- Comfort kit is running low — the nurse can arrange refills
- Equipment problems — hospital bed, oxygen, suction machine
- You're not sure what's happening — if something feels wrong, call. That's what they're there for.
- You're overwhelmed — they can send help, arrange respite, or just talk you through it
- After death occurs — call hospice first. There is no rush. The nurse will come to you.
- When death occurs — paramedics are legally required to attempt resuscitation. Call hospice instead.
- When they stop eating or drinking — this is expected. The hospice team is managing it.
- When breathing changes — irregular breathing, pauses, and the "death rattle" are part of the dying process.
- When they become unresponsive — this is a natural progression. Call your nurse, not 911.
- When they have a fall (unless you suspect a broken bone you can see) — call hospice for assessment.
- When they seem confused or agitated — this is terminal restlessness. Your nurse has medications for this.
- Fire or gas leak in the home
- Caregiver medical emergency — if YOU are having a heart attack, stroke, or medical crisis
- Violence or intruder — a safety threat to anyone in the home
- Natural disaster — flood, tornado, or structural collapse
These are emergencies where the patient's hospice status is not relevant. In these cases, call 911 AND your hospice team.
- Understanding pain at end of life
- Common pain medications explained
- Morphine myths debunked
- Non-drug comfort measures
- How to manage breakthrough pain
- When and how to give rescue doses
The Comfort Kit — Medications Explained
Your hospice team may leave a small kit of medications at home for fast symptom relief. Here's what each one does, in plain language.
🤲 Beyond Medications — Comfort Tips
Sometimes the most powerful comfort measures don't come from a bottle.
A cool, damp washcloth on the forehead, neck, or wrists can bring real relief — especially with fever or restlessness. Refresh it often. Simple, immediate, and something you can always do.
Lower the lights, turn off the TV, minimize visitors coming and going. A calm room helps reduce agitation and restlessness. Soft music or nature sounds can be soothing — but silence is OK too.
Hearing is believed to be one of the last senses to go. Even when your loved one can't respond, they may still hear you. Speak gently. Say what you need to say. Your voice is a comfort they recognize.
If extended family can't be there in person, put them on speakerphone or video call. Let them talk to your loved one. The familiar voice of a grandchild, a sibling, or an old friend can be deeply meaningful — even if there's no visible response.
When they stop drinking, the mouth dries out quickly. Use damp mouth swabs, a wet washcloth, or lip balm to keep lips and mouth moist. This is one of the most comforting things you can do.
For shortness of breath, a small fan blowing gently toward the face can reduce the sensation of air hunger. This works even better than you'd expect — studies show it's as effective as low-flow oxygen for some patients.
Hold their hand. Gently rub their arm. Sit beside them. You don't need to talk. Physical presence and gentle touch release oxytocin and reduce stress — for both of you.
Turning them slightly every few hours prevents pressure sores and can ease breathing. Use pillows to support. Your nurse can show you how to do this safely and comfortably.
Questions to Ask Your Hospice Team
You don't have to figure this out alone. Here are the questions other families wish they'd asked sooner — organized by who to ask.
Glossary of Terms
Hospice has its own language. Here's what the words actually mean — in plain English.
- The truth about caregiving
- Recognizing burnout — signs to watch for
- Respite care: your right to rest
- Asking for help: real scripts you can use
- Understanding anticipatory grief
- Your physical health matters too
Caregiver Support & Resources
Caregiving is one of the hardest things a person can do. You cannot pour from an empty cup. These resources are here for you.
If You're in Crisis
Caregiver burnout is real. You matter too.
Respite & Caregiver Relief
Practical Help
The body does not stop eating because it is starving. It stops eating because it is done. There is a difference.
- Weeks before: sleep, appetite, withdrawal
- Days before: body changes to expect
- Hours before: breathing, color, awareness
- What is "normal" vs. what needs a call
- How to provide comfort at each stage
- The moment of death — what it looks like
What's Happening — A Timeline
The physical and emotional changes you may see as your loved one approaches the end of life. Every person is different — this is a general guide, not a script.
What You May Notice
- Less appetite — decreased interest in food, weight loss
- More sleep — growing fatigue, longer naps, less energy
- Withdrawal — less interest in activities, visitors, or conversation
- Increased pain or nausea — may need medication adjustments
- More infections — weakened immune system makes illness more likely
- Emotional changes — introspection, life review, sometimes sadness or peace
What You Can Do
- Offer smaller, favorite meals — don't force eating
- Let them rest when they need to
- Respect their need for quiet time
- Talk to the hospice team about pain management
- Be present — your company matters even in silence
- Take care of yourself, too — you can't pour from an empty cup
What You May Notice
- Sleeping most of the day — may be difficult to wake
- Stops eating — this is the body's way of preparing, not starvation
- Restlessness — picking at sheets, trying to get up, agitation
- Confusion — may not recognize you, or may seem disoriented
- Hallucinations — seeing or talking with deceased loved ones (this is common and often comforting to the patient)
- Congestion — noisy, gurgling breathing as secretions build
- Difficulty swallowing — pills may no longer be possible
- Vital sign changes — temperature swings, weaker pulse
What You Can Do
- Keep their mouth moist with damp sponges or lip balm
- Don't force food or water — it can cause choking or discomfort
- Speak calmly and reassuringly during confused periods
- Don't argue with hallucinations — they're rarely frightening to the patient
- Elevate the head of the bed to ease breathing
- Ask the hospice nurse about liquid or sublingual medications
- Create a calm, quiet environment with soft lighting
- Play their favorite music softly
What You May Notice
- Bedbound — unable to get up or do any activity
- Skin color changes — bluish, mottled, or purplish patches on knees, feet, hands
- Cheyne-Stokes breathing — several rapid breaths, then a long pause, then rapid breaths again
- Less responsive — may not react to voice or touch
- Eyes change — may be glassy, half-open, or non-reactive to light
- Decreased urine — output drops significantly or stops
- Drop in blood pressure — the body is slowing down
- Facial changes — relaxation of facial muscles
What You Can Do
- Continue talking to them — hearing is one of the last senses to go
- Hold their hand — touch is powerful even when they can't respond
- Keep them warm with light blankets
- Gently reposition every few hours for comfort
- Use the comfort kit medications as instructed by your nurse
- Say what you need to say — "I love you," "Thank you," "I'll be OK"
- It's OK to cry, and it's OK to just sit quietly
What You May Notice
- Death rattle — a gurgling or rattling sound from fluid in the throat. Sounds worse than it feels — your loved one is not choking
- Long pauses in breathing (apnea) — gaps grow longer
- Mouth open — jaw relaxes, breathing through the mouth
- Cold, mottled extremities — hands and feet may be cool and purplish
- Eyes glassy — may not close fully
- Pulse very weak or absent at the wrist
- A brief surge of energy — sometimes, a surprising moment of alertness or clarity right before the end (called "terminal lucidity")
What You Can Do
- Keep talking softly — they may still hear you
- Play their favorite music or read something meaningful
- Hold their hand or gently touch their forehead
- If the death rattle is distressing, atropine drops can help (ask your nurse)
- You don't have to do anything — just being there is enough
- It's OK to step out of the room — some people wait to pass until they're alone
- When breathing stops, there is no rush. Sit with them. Call hospice when you're ready.
The Journey — At a Glance
A visual overview of what to expect as the body begins to slow down. Every person is different — this is a general guide, not a rulebook.
"Is This Normal?"
Things that look alarming but are actually a normal part of the dying process. Knowing what to expect can save you from panic.
- The first moments — what to do (and not do)
- Who to call and in what order
- What happens with the body
- Practical steps in the first 48 hours
- The death certificate process
- Bereavement support available to you
After Death — The First 48 Hours
When the moment comes, there is no rush. Here is a step-by-step guide for what happens next — and what you do NOT need to do right away.
Grief & Bereavement Support
Find a Funeral Home Near You
If you haven't chosen a funeral home yet, you can search here. Each listing includes a "Questions to Ask" checklist based on your rights under the FTC Funeral Rule.
Clinical wisdom and practical advice from 15 years at the bedside.
Waldo, NP
Have a question? Ask Waldo.
Caregiving, hospice, medications, "is this normal?" — no question is too small.
I read every question personally. Whether it's something medical, something emotional, or just "is this normal?" — ask.