Hospice is everywhere. California has over 1,200 hospice providers, a roughly 10-fold increase in the last decade. Why the growth? Because hospice can be a very profitable business, and it has very little government oversight.
At Southern California Nursing Home Law Group, we frequently hear that same story: Mom or dad has some health event and skilled nursing, or assisted living is recommended. At the time of admission, an employee of the facility asks (out of the blue), “have you considered putting mom/dad on hospice?”
“Hospice?” a family member responds, “but mom/dad is not dying.”
The employee goes on to explain that hospice is not just for the dying anymore, and it will provide extra care at no cost to the family or the resident, so most families agree to the services. Extra care at no cost, who would say no?
The truth is, to qualify for hospice services a person must be terminally ill, and a licensed physician must affirm that the patient is likely to live no more than six months. Moreover, Medicare has strict criteria as to what level of illness qualifies someone for hospice. So if you loved one is enrolled in hospice in a nursing home or assisted living facility, you can be sure most of the staff believe your loved one is dying of a terminal illness.
So, what happens if a loved one is enrolled in hospice, but you don’t believe they are dying, and your loved one has a medical emergency. Are you allowed to call 911?
Yes, you can still call 911 if a patient is on hospice in a nursing home, but it is important to understand the context and goals of hospice care. Hospice care focuses on comfort and quality of life rather than curative treatment. Here are some guidelines to consider:
Emergency Situations: If you don’t believe that your loved in is dying of a terminal illness and there is an unexpected and severe change in the patient’s condition, such as a sudden and severe pain that cannot be managed by hospice staff, severe respiratory distress, or other acute symptoms that require immediate attention, you should call 911.
Discuss with the Hospice Team: It is essential to have a conversation with the hospice team about the specific wishes and care plan for the patient. This can help clarify situations where calling 911 aligns with the patient’s goals and where it might not.
Comfort and Symptom Management: Hospice care aims to manage symptoms and provide comfort. The hospice team is usually equipped to handle most situations that arise in the course of a terminal illness. However, if the hospice staff cannot reach the patient quickly enough or the symptoms are beyond their immediate control, calling 911 might be necessary.
Patient and Family Wishes: Respecting the wishes of the patient and their family is crucial. If the patient or family has specific instructions regarding emergency care, these should be followed. Some patients may have advance directives or Do Not Resuscitate (DNR) orders in place, which should be respected.
Hospice Protocols: Each hospice organization may have specific protocols for emergencies. Familiarize yourself with these protocols to ensure you are acting in accordance with the patient’s care plan and hospice guidelines.
In summary, while it is generally not common to call 911 for patients on hospice due to the focus on palliative care, there are situations where it may be appropriate. Clear communication with the hospice team and understanding the patient’s wishes and care plan are key to making the best decision in an emergency.