The question of whether to call 911 for a loved one receiving hospice care is a common source of stress for families navigating a medical emergency. Hospice care shifts the focus from curative treatment to comfort and quality of life, which creates a conflict when an acute crisis arises. Families are often unsure if their instinct to dial emergency services should be overruled by the hospice philosophy. This article provides practical guidance to help families understand the principles of hospice care and the specific protocol to follow when an emergency occurs.
Understanding Hospice Care and Your Right to Emergency Services
Hospice care is a specialized form of palliative care for individuals with a terminal illness, typically defined as having a prognosis of six months or less if the disease runs its expected course. The core philosophy centers on symptom management, emotional support, and dignity, rather than aggressive medical intervention to cure the disease or prolong life. This focus on comfort is distinct from the curative goal of typical hospital care, which 911 services are generally equipped to support.
Despite this shift in care philosophy, any person in the United States, including a patient enrolled in hospice, maintains the legal right to access emergency medical services (EMS) at any time. No hospice enrollment can override a person’s right to call 911 or receive transport to a hospital.
When a hospice patient is transported to a hospital and receives curative treatments, they are often considered to have “revoked” their hospice status. Electing to pursue a cure-focused treatment for the terminal illness legally ends the hospice benefit. This choice carries administrative and financial consequences, as the patient is discharged from hospice and the insurance coverage changes.
The Essential First Call: Contacting the Hospice Team
The standard and most recommended protocol for a patient in hospice care who is experiencing an emergency is to contact the hospice team first, not 911. The hospice agency provides 24-hour on-call support, ensuring that a registered nurse or other clinical staff member is available at any time. This immediate access to a medical professional familiar with the patient’s specific condition and care plan is a significant benefit of hospice enrollment.
This initial call allows the hospice nurse to triage the situation, assessing the severity of the symptoms and determining the appropriate response. The team is equipped to manage many crises that may seem like a 911 emergency to an untrained caregiver, such as severe pain, uncontrolled nausea, or acute shortness of breath. They can often provide immediate guidance over the phone, arrange for an emergency home visit, or authorize specific comfort medications to be administered right away.
The hospice team’s primary goal is to manage symptoms in a way that aligns with the patient’s goals of care, focusing on maximizing comfort at home. If EMS is deemed necessary, the hospice nurse can coordinate the call, providing emergency responders with specific instructions and clarifying the patient’s advance directives, such as a Do Not Resuscitate (DNR) order. This coordination helps ensure that any necessary transport or intervention is consistent with the patient’s end-of-life wishes. Calling the hospice team first prevents unnecessary invasive procedures that conflict with the patient’s desire for a peaceful course of death.
Consequences of EMS Involvement: Patient Status and Cost
When 911 is called and EMS personnel arrive, their actions are primarily governed by legal mandates and immediate life-saving protocol. Emergency medical technicians (EMTs) are legally obligated to attempt resuscitation and stabilization unless a valid, clearly presented physician order, such as a state-specific Do Not Resuscitate (DNR) order or a Physician Orders for Life-Sustaining Treatment (POLST) form, is available. If these documents are not readily accessible, EMS must proceed with all available life-saving measures, which can include cardiopulmonary resuscitation (CPR) and intubation.
If the patient is transported to a hospital by ambulance and receives curative care for their terminal diagnosis, they are typically considered to have revoked the hospice benefit. The Medicare hospice benefit, which covers all care related to the terminal illness, is contingent on the patient choosing comfort care over curative treatment.
This revocation means that the patient’s standard Medicare coverage is reinstated, but the family is now responsible for any out-of-pocket costs, deductibles, and co-pays associated with the ambulance transport and the hospital stay. Costs associated with an emergency room visit or hospital admission are generally not covered under the hospice benefit unless the hospice agency specifically coordinated the visit for symptom management. Receiving curative treatments for the terminal illness will terminate the hospice coverage and result in significant financial liability for the patient or family. The administrative and financial risks associated with bypassing the hospice protocol underscore the importance of contacting the hospice team as the first step in any emergency.