Referring a patient to hospice is one of the most important decisions a care team makes, and it’s often one of the hardest to time correctly. Physicians, case managers, discharge planners, and nurses all play a role in recognizing when a patient may benefit from hospice care and starting that conversation with the patient and family. This guide walks care teams through the referral process step by step, from recognizing eligibility to what happens after the referral is submitted.

When to Consider a Hospice Referral

Hospice is appropriate when a patient has a life-limiting illness and a physician certifies a prognosis of six months or less if the disease follows its expected course. In practice, the signals often show up earlier than teams expect: frequent hospitalizations, declining response to curative treatment, weight loss, increased fatigue, or a patient and family who have started talking about comfort-focused goals of care.

Care teams don’t need to wait for a patient to be actively dying to make a referral. Earlier referrals generally mean more time for the hospice care team to manage symptoms, support the family, and help the patient stay comfortable at home. If your team is unsure whether a patient meets criteria, our hospice eligibility page breaks down the diagnosis-specific guidelines we use, and our clinical team is always available to talk through a specific case before a formal referral is submitted.

The Hospice Referral Process, Step by Step

The referral process is designed to be simple for care teams, since the goal is to reduce friction at a point when everyone involved is already managing a lot.

• Step 1: Identify the patient and initiate the conversation. This starts with the physician or care team recognizing a decline in condition or a shift in the patient’s goals of care. A brief conversation with the patient and family about what hospice is and isn’t can make the eventual referral much smoother.
• Step 2: Obtain physician certification. A hospice referral requires certification from the patient’s attending physician (or the hospice medical director, if there isn’t an attending physician) confirming the six-month prognosis if the illness runs its expected course.
• Step 3: Submit the referral. Referrals can be made by phone or through our online referral form, and can come from a hospital, skilled nursing facility, physician’s office, or directly from a patient’s family. We accept referrals 24/7, so timing around a weekend discharge or a sudden decline doesn’t hold up the process.
• Step 4: Care team assessment. Once a referral is received, our hospice care team-including a registered nurse and, as needed, a social worker or chaplain-completes an in-person assessment, usually within 24 to 48 hours, to confirm eligibility and begin building a care plan.
• Step 5: Care begins. Hospice care can start the same day the assessment confirms eligibility, wherever the patient calls home. Our post on starting hospice care walks families through what those first days typically look like.

Common Referral Barriers and How to Address Them

Care teams sometimes hesitate to bring up hospice, and the hesitation usually comes from one of a few places: uncertainty about timing, concern that the family isn’t ready, or simply not knowing what hospice actually covers day to day.

The most effective referrals treat hospice as an addition to the patient’s care, not a withdrawal of it. Framing the conversation around comfort, symptom management, and time with family-rather than around “stopping treatment”-tends to land better with both patients and families. It also helps to have a direct answer ready when families ask about cost, since that’s frequently the first question.

Learn more: Who Pays for Hospice Care?

What Families Can Expect After the Referral

Once a referral is submitted and the patient is admitted, families often aren’t sure what changes and what stays the same. Hospice care typically takes place wherever the patient lives, whether that’s a private residence, an assisted living facility, or a nursing home, with the care team coming to the patient rather than the other way around.

For a deeper look at how hospice fits into a patient’s existing living situation, our post on where hospice happens covers the settings hospice care can be delivered in and what the care team’s role looks like in each one.

Supporting Patients Across Care Settings

Care teams referring from hospitals, skilled nursing facilities, or physician practices across Virginia can count on the same referral process regardless of where the patient lives. We serve families throughout our service areas, including Richmond, Lynchburg, Roanoke, Fredericksburg, Harrisonburg, Farmville, and Winchester, along with the surrounding communities in each region.

If your facility is weighing hospice options for a patient in a specific area, our post on choosing a hospice provider in Lynchburg, VA outlines the questions worth asking any hospice provider, not just ours.

Frequently Asked Questions for Referring Providers

• Can a referral come from someone other than the attending physician? Yes. Referrals can come from hospital case managers, discharge planners, skilled nursing facilities, or family members, though physician certification is still required before care begins.
• How quickly can hospice care start after a referral? In most cases, an assessment happens within 24 to 48 hours, and care can begin the same day eligibility is confirmed.
• What if the patient doesn’t have a terminal diagnosis on paper yet? Our team can help evaluate whether a patient’s overall clinical picture supports a hospice referral, even if the underlying diagnosis isn’t the primary driver of decline. See our FAQs page for more on eligibility questions we hear often.
• Does referring to hospice mean discontinuing all other care? No. Hospice adds a layer of comfort-focused support and symptom management; it doesn’t replace the patient’s existing physician relationships or take away non-curative treatments aimed at comfort.

Making a Referral

If your care team has a patient who may benefit from hospice, we’re ready to help you figure out the right next step, whether that’s a referral today or a conversation about eligibility first. You can submit a referral online or call our team directly at (855) 415-5744 any time.