Can you call 911 on hospice? What to do instead

Why call the hospice first?

Because the hospice can do at home most of what an emergency room would do for a person on hospice, without the ambulance, the waiting room and the tests. The nurse knows the person, the medicines in the house and the plan of care. Paramedics and emergency staff do not, and they are trained to treat everything as an emergency. For a person whose goal is comfort at home, that can mean a hospital stay nobody wanted.

There is a coverage reason as well. Medicare pays for emergency room, hospital and ambulance care for the terminal illness only when the hospice team arranged it or the care is for a condition unrelated to the terminal illness. If the hospice decides a hospital stay is needed, the hospice makes the arrangements. A trip the hospice did not arrange can leave the family with the bill. See what hospice does and does not provide.

Who do you call?

The rule is simple: for anything about the illness, the hospice; for an emergency that has nothing to do with the illness, 911.

If the hospice team has told you something different for your situation, follow the team's instructions.

What happens when you call the hospice?

The same four steps, day or night.

1. Step 1

   A nurse answers

   A hospice nurse answers the phone 24 hours a day, 7 days a week. Tell the nurse what you see, when it started and what you have already tried.

2. Step 2

   The nurse assesses

   By phone first, and with a visit when needed. The nurse checks symptoms, adjusts medicines with the hospice doctor, and sees whether the problem can be managed where the person is.

3. Step 3

   The team decides the level of care

   If symptoms cannot be controlled with routine visits, the hospice can provide a higher level of care when medically necessary during a symptom crisis: continuous home care to keep the person at home, or general inpatient care in a contracted hospital or facility. The hospice arranges the bed and the transport. See the four levels of hospice care.

4. Step 4

   Care steps back down

   When the crisis settles, care returns to routine home care. Nothing changes without the patient or their representative knowing.

What if someone already called 911?

It happens, often when a visitor or a neighbor is the one who finds the person. Calling 911 brings paramedics who may be required to attempt resuscitation and transport the person to a hospital. Show the responders the person's POLST form if there is one, tell them the person is on hospice, and call the hospice right away. The nurse can speak with the paramedics and with the hospital. Keep the POLST where it can be found; the refrigerator door is the usual place. See advance directives and POLST in California.

Common questions

Read more

Signs that death is near, and when to call us, what to do when your loved one dies at home, the four levels of hospice care and what to expect in the first week.