A Simple Guide to Getting Started

Starting hospice care involves three simple steps: a phone consultation to discuss your situation, an in-person assessment with a registered nurse, and enrollment with your personalized care plan. Most families begin receiving care within 24 hours.

Medicare, Medicaid, and most insurance plans cover all hospice services, so there’s no financial barrier to getting the support your family needs.

Talk to Our Care Team

Before You Call: What You Should Know

You don’t need a formal referral to start hospice care, though many families come to us through their doctor, hospital discharge planner, or a friend who’s used our services.

You can call us directly at (804) 273-3000 whether or not your physician has mentioned hospice. We’ll work with your doctor to confirm medical eligibility and coordinate care.

What Makes Someone Eligible for Hospice?

According to Medicare guidelines, hospice care is appropriate when:

• A physician certifies that life expectancy is six months or less if the illness follows its natural course
• The focus of care shifts from curative treatment to comfort and quality of life
• The patient (or their healthcare representative) chooses hospice care

Common qualifying diagnoses include cancer, congestive heart failure, COPD, dementia, end-stage kidney or liver disease, ALS, and stroke with severe complications.

Not sure if your loved one qualifies? That’s exactly what the first conversation is for. We’ll help you determine eligibility without any pressure or obligation.

Learn more about hospice eligibility → Hospice Eligibility Guidelines

Step 1: The First Phone Call (No Commitment Required)

Starting hospice begins with a simple phone conversation. Call (855) 415-5744 and tell us what’s happening. A registered nurse or intake coordinator will listen to your situation and ask a few questions:

• What is your loved one’s current diagnosis?
• What symptoms are they experiencing?
• What treatments have they tried?
• Where are they currently receiving care (home, hospital, facility)?
• What kind of support does your family need most?

This conversation is about clarity, not commitment. We’re not here to pressure you into enrolling. We’re here to help you understand whether hospice is the right fit for your family right now.

If hospice isn’t appropriate yet, we’ll tell you honestly and suggest other resources. If it is the right time, we’ll explain what happens next and answer every question you have, in plain language, without medical jargon.

Most families tell us they feel relief after this first call, simply because someone finally understands what they’re going through and knows how to help.

Step 2: The In-Person Assessment (Usually Within 24 Hours)

Once you’re ready to move forward, we schedule an in-person assessment, often the same day or within 24 hours. A registered nurse from James River Home Health & Hospice will come to wherever your loved one is: your home, a hospital room, an assisted living facility, or a skilled nursing home.

What Happens During the Assessment?

The nurse will:

• Review Medical History
  We’ll discuss diagnoses, current medications, recent hospitalizations, and what treatments have been tried.
• Assess Current Symptoms
  We’ll evaluate pain levels, breathing difficulties, mobility, appetite, and any other symptoms affecting comfort.
• Discuss Goals of Care
  We’ll talk about what matters most to your loved one and your family, whether that’s staying at home, managing pain, or having time for important conversations.
• Verify Insurance Coverage
  We’ll confirm Medicare, Medicaid, or private insurance benefits so you know exactly what’s covered (which is nearly everything).
• Create a Personalized Care Plan
  Based on your loved one’s needs, we’ll develop a plan that includes visit schedules, medications, equipment, and support services.
• Answer Your Questions
  You’ll have time to ask about anything you’re worried about, from who will visit to what happens at the end of life.

This visit typically lasts 60–90 minutes. It’s unhurried, compassionate, and entirely focused on understanding your unique situation.

What Documents Do You Need?

You don’t need to gather a pile of paperwork before the assessment. We’ll help you with everything. But it’s helpful to have:

• A list of current medications (or the medication bottles themselves)
• Recent hospital discharge papers (if applicable)
• Insurance cards (Medicare, Medicaid, or private insurance)
• Contact information for your loved one’s primary physician
• Healthcare power of attorney or advance directive (if already completed)

Don’t worry if you don’t have everything. We’ll work with you to gather what’s needed and help complete any missing documents.

Step 3: Enrollment and Care Begins

If everyone agrees that hospice is the right choice, enrollment happens during or shortly after the assessment visit.

What You’ll Sign

• Hospice Election Form
  This document confirms your loved one’s choice to receive hospice care instead of curative treatment for their terminal illness. You can revoke this at any time if circumstances change.
• Consent for Care
  Standard consent forms that authorize our team to provide medical care and services.
• Notice of Privacy Practices
  HIPAA-compliant documentation about how we protect health information.
• Advanced Directives (if not already completed)
  Our social worker can help you complete documents like a living will, healthcare power of attorney, or DNR order if desired.

Your nurse will explain every document in plain language. You’ll never be asked to sign something you don’t understand.

What Happens in the First 24-48 Hours?

Once enrollment is complete, things move quickly:

• Medical Equipment Arrives – A hospital bed, oxygen concentrator, wheelchair, walker, bedside commode; whatever your loved one needs for comfort and safety is delivered to your home, usually within hours.
• Medications Are Delivered – Comfort medications for pain, nausea, anxiety, breathlessness, and other symptoms arrive quickly, along with clear instructions on how to use them.
• Your Care Team Contacts You – You’ll hear from your registered nurse, certified nursing assistant, social worker, and other team members to schedule initial visits.
• 24/7 Support Begins Immediately – From the moment you enroll, you have round-the-clock access to our clinical team. If something changes or you have questions at 2 a.m., you can call and speak directly to a nurse.
• First Visits Are Scheduled – Your nurse typically visits within the first 24 hours to ensure the care plan is working, symptoms are controlled, and you have everything you need.

Most families are surprised by how quickly everything happens. There’s no waiting. When you need help, we respond immediately.

What If You’re Starting Hospice from the Hospital?

Many families choose hospice while their loved one is still hospitalized. This is completely normal and often happens during a hospital stay when curative treatment is no longer effective.

Here’s how it works:

1. Hospital Staff or Physician Suggests Hospice. Social workers, case managers, nurses, or physicians explain that hospice may be appropriate and can help coordinate the transition.
2. We Meet You at the Hospital. Our team comes to the hospital room to share additional information with you about hospice care. In some instances, our team may initiate care while you are still in the hospital. Where appropriate, our team will begin coordinating with the hospital to prepare for discharge.
3. We Coordinate with the Hospital to Plan a Safe Discharge. We work directly with hospital staff to arrange a safe, comfortable discharge to home or another facility. We coordinate with the transportation company to understand when you will arrive home, arrange for medical equipment to be delivered to your home, and ensure necessary medications have been ordered.
4. Care Begins Quickly After Discharge. A nurse is often waiting at your home when you arrive, ready to settle your loved one in and ensure comfort from the first moment.
   
   We are here to support you so that the transition is smooth and stree-free.

Starting Hospice from Assisted Living or Skilled Nursing

If your loved one lives in an assisted living community, memory care unit, or skilled nursing facility, hospice care can start there too.

We work directly with facility staff to coordinate care, manage medications, and provide additional support beyond what the facility offers. Your loved one doesn’t have to move, hospice comes to them.

You Can Start Today

Starting hospice care doesn’t require weeks of planning or perfect timing. It requires one phone call. Our team is available 24/7 at (855) 415-5744. We’ll answer your questions, walk you through the process, and help you determine if hospice is right for your family. No pressure. No judgment. Just honest, compassionate guidance.

If your loved one is struggling with symptoms, if you’re overwhelmed trying to provide care alone, or if a doctor has mentioned hospice and you’re not sure what to do next: call us today.