Hospice care is a specialized service centered on providing comfort and maximizing the quality of life for a person with a terminal illness. This palliative approach shifts the focus away from life-prolonging treatments toward managing pain and symptoms, typically provided in the patient’s home. While any person can technically dial 911, doing so for a hospice patient often introduces aggressive medical interventions that conflict with the established care plan. The decision to involve emergency services must be carefully weighed against the patient’s documented wishes for a dignified, natural death focused on comfort.
The Immediate Decision: Who to Call During an Emergency
When a crisis occurs, the most appropriate response for a hospice patient is to contact the provider’s dedicated 24/7 support line. Every accredited hospice agency maintains a continuous phone service staffed by nurses familiar with the patient’s condition, medications, and end-of-life goals. This team is trained to manage sudden symptom changes using the patient’s pre-supplied comfort kit medications. They offer immediate guidance, dispatch a hospice nurse, or coordinate with the attending physician to adjust the care plan.
Calling 911 activates the Emergency Medical Services (EMS) system, which operates under a default mandate to sustain life. Paramedics are obligated to initiate aggressive, life-prolonging measures, including cardiopulmonary resuscitation (CPR), unless presented with specific, legally valid documentation stating otherwise. This response often involves rapid transport to a hospital emergency department, which can be disorienting and uncomfortable for a fragile patient. The hospice team is equipped to manage the crisis within the patient’s comfort goals, making them the preferred initial point of contact for non-imminent emergencies.
The Conflict Between Emergency Services and Hospice Goals
The fundamental conflict lies in the differing philosophical goals of care between hospice and the standard emergency medical system. Hospice care is defined by its palliative intent, focusing on symptom management and supporting a natural dying process. In contrast, 911 and hospital emergency rooms are built around a curative model, where the objective is to diagnose the crisis and intervene aggressively to prolong life. These two approaches are mutually exclusive when a patient has elected to forgo curative treatment.
The interventions EMS is trained to perform are highly invasive procedures:
- Chest compressions during CPR
- Mechanical ventilation
- Intubation
- Electrical defibrillation
For a patient with a terminal prognosis, these actions rarely result in a meaningful recovery and often prolong the dying process painfully. Transport to an emergency room subjects the patient to diagnostic tests and procedures that violate the patient’s wish for dignity and comfort at the end of life. This aggressive intervention directly undermines the core principles of the hospice benefit.
How Legal Documents Guide EMS Response
The authority to bypass life-prolonging intervention rests entirely on the presence of specific, legally recognized medical orders that are immediately available to the first responders. The most common forms are the Do Not Resuscitate (DNR) order and the Physician Orders for Life-Sustaining Treatment (POLST), which is often state-specific and may be called a Medical Orders for Life-Sustaining Treatment (MOLST). These documents are legally binding orders signed by a physician that direct pre-hospital personnel, like paramedics, to withhold resuscitation attempts in the event of cardiac or respiratory arrest.
A standard Advance Directive or Living Will, which outlines general end-of-life wishes, is not sufficient to guide EMS in an emergency. These broader documents are typically used for in-hospital care decisions and are not recognized as a standalone order by emergency crews on the scene. If a valid, state-approved DNR or POLST form is not visually presented and accessible to the paramedics upon arrival, they are legally required to attempt full resuscitation and transport the patient to the nearest hospital, regardless of verbal instructions from family or caregivers.
Implications of Hospital Admission While on Hospice Care
If the decision is made to call 911 and the patient is transported to a hospital emergency department, there are significant administrative and clinical consequences. Hospital admission for an issue related to the terminal diagnosis is often considered a pursuit of curative care. Seeking aggressive treatment or diagnostic assessment in a hospital setting typically results in the automatic suspension or revocation of the Medicare Hospice Benefit.
The hospice benefit is designed to cover palliative care in the home, and its eligibility is based on the decision to forgo curative treatment. Once the patient is admitted to the hospital, the financial responsibility for all care related to the terminal condition shifts from the hospice agency to the patient or their primary insurance. This can lead to unexpected and substantial out-of-pocket costs. Furthermore, re-establishing hospice coverage after discharge requires a new certification process and re-enrollment, which adds administrative complexity and stress.