When you have a loved one whose care needs have advanced, it’s easy to feel uncertain about next steps, especially if you’re considering hospice care. Understanding who can make a referral for inpatient hospice, including who initiates it and how eligibility works, can help you navigate the process and make the best decision for your family during a difficult time.

In this article, we’ll clarify who can make an inpatient hospice referral, how long it takes for approval and what qualifies someone for inpatient hospice. We’ll also share a brief overview of how the inpatient hospice referral process works. 

At 3HC, we’re dedicated to providing comprehensive inpatient hospice services while treating you like family. Our inpatient hospice care centers provide expert, compassionate care in a peaceful environment focused on comfort and quality of life. We invite you to get in touch with us to learn more and get care. 

Who is Responsible for Making a Referral for Inpatient Hospice?

Inpatient hospice is designed to provide short-term, around-the-clock care for patients with serious symptoms that have become too difficult to manage at home. 

A common misconception about hospice care is that only a doctor can make a referral. Though a physician is often involved, other people can also initiate the process.

Those who can make a referral for inpatient hospice include:

• Physicians, including primary care doctors or specialists
• Hospital staff or care teams, such as case managers, discharge planners or social workers
• Family members, friends, caregivers or neighbors
• The patient themselves

A physician’s certification of a terminal illness with a prognosis of 6 months or less is required for Medicare or Medicaid coverage, though the initial referral does not have to come from a doctor. 

A referral doesn’t automatically mean admission to hospice, rather, it starts the evaluation process to determine if the patient is qualified and to assess their needs. 

3HC offers a 24-hour referral line at 1-800-692-4442. With one call we can connect you to a member of our 3HC family at a location near you.

How Long Does It Take for an Inpatient Hospice Referral to Be Approved?

In most cases, the inpatient hospice approval process progresses quickly. 

As hospice providers, we understand that patients referred for this level of care may be experiencing severe symptoms that need immediate attention, so we prioritize timeliness. 

A typical timeline may look like this:

• After the initial contact is made, we often respond within hours. 
• An evaluation is usually completed the same day or within 24 – 48 hours, depending on how quickly medical information can be reviewed.
• Admission can happen quickly after that if guidelines are met.

If your loved one meets the necessary criteria, inpatient hospice admission can sometimes happen as quickly as the same day. We prioritize urgent cases that involve severe pain or breathing challenges.

Factors that influence timing include:

• How quickly a physician’s certification can be obtained
• How severe the patient’s symptoms are, with urgent cases prioritized
• Availability of medical records

Our goal is to minimize delays and provide support as quickly as possible.

What Criteria Must a Patient Meet for Inpatient Hospice Admission?

While we strive to provide care in the comfort of your home, there are times when the appropriate level of care can’t be managed at home. In these cases, we offer inpatient hospice care centers that provide expert, compassionate care in a peaceful, home-like environment.

There are two sets of criteria a patient must meet to qualify for inpatient hospice: general hospice eligibility and the need for a higher level of care.

For general hospice eligibility:

• A physician must determine that the patient has six months or less to live if the illness follows its natural course.

• The patient has chosen to focus on comfort-focused care and quality of life rather than curative treatment. 

For higher-level inpatient care, qualifying conditions include:

• Complex wound care
• Severe or uncontrolled pain 
• Persistent nausea or vomiting 
• Frequent, uncontrolled seizures 
• Difficulty breathing or respiratory distress 
• Use of IV or other medications that need close monitoring or adjustments
• The necessity of minor procedures for patient comfort (such as a drainage tube)

An inpatient hospice stay is often short-term for the purpose of managing acute symptoms that can’t be handled at home. Patients may return home once symptoms are stabilized and can be controlled safely. 

Inpatient Hospice Referral Process

The inpatient hospice referral process is meant to be simple and straightforward for families to navigate. 

Referral process steps include:

• Recognizing the need
  • The healthcare provider, family or patient notices declining health, worsening symptoms or other signs that at-home care is no longer sufficient. 
  • Conversations about goals (comfort vs treatment) begin.

• Making the referral
  • A physician, hospital staff member, family member or patient contacts a hospice provider.
  • Basic patient information and medical history are shared.

• A hospice evaluation 
  • The hospice team reviews medical records.
  • A physician certifies that the patient meets hospice eligibility requirements.
  • The hospice evaluation assessment involves a physical exam, a review of medical history and consideration of emotional and spiritual support needs.

• An admission decision
  • If criteria are met, inpatient hospice is approved.
  • A personalized care plan is created.

• Transition into care
  • The patient is admitted to the inpatient care facility.
  • The care team, including nurses, doctors and support staff, begins around-the-clock care and symptom management.

Our caring hospice team will work closely with you and your family to provide support and guidance through every step of the process. 

3HC Inpatient Hospice Houses: Expert, Compassionate Care in a Comfortable Environment 

Understanding how inpatient hospice works can make a challenging time a little more manageable. The process is designed to be supportive and straightforward for families to manage and usually progresses quickly to ensure your loved one receives timely care. 

When your loved one’s needs can no longer be managed at home, our inpatient hospice houses provide expert, compassionate care in a peaceful environment focused on comfort and quality of life. At 3HC, we’re dedicated to caring for your family as if they were our own.

We invite you to get in touch with us to learn more and get care.