Families often spend weeks, sometimes months, researching hospice, weighing the decision, and working up the courage to make the call. Then, once the paperwork is signed, the question shifts almost immediately: What happens now? When does someone show up? What do we actually do?

The first 48 hours of hospice care are more active and more structured than most families expect. This is not a waiting period. From the moment enrollment is confirmed, your care team is already moving, coordinating medications, planning visits, and preparing to be at your loved one’s side.

Here is exactly what that looks like.

Within the First Few Hours: The Intake Nurse Visit

The first person to arrive at your home after enrollment is typically a registered nurse completing what is called an initial assessment or admission visit. At James River Home Health & Hospice, this visit happens quickly – often the same day enrollment is confirmed, or within hours of the paperwork being completed.

This visit has two purposes. The first is clinical: the nurse conducts a thorough assessment of your loved one’s current condition, pain levels, symptoms, medications, and immediate comfort needs. The second is relational: this is the beginning of a care relationship, and a good hospice nurse knows that families need to feel heard before they can feel supported.

During this visit, your nurse will:

• Review all current medications and identify what needs to be adjusted, added, or discontinued
• Assess pain and symptom management needs immediately
• Gather a full picture of your loved one’s medical history, diagnosis, and current status
• Begin building the individualized plan of care that will guide every subsequent visit
• Answer your family’s most pressing questions about what comes next
• Explain who will be on your care team and how to reach them

This visit is not a formality. It is the foundation for everything that follows. To understand the full scope of who will be involved in your loved one’s care from day one, visit: Hospice Care Team.

Within 24 Hours: Medications and Equipment Arrive

One of the most meaningful things hospice does on the first day is remove the logistical burden from the family entirely.

Medications related to your loved one’s terminal diagnosis and comfort are ordered through a hospice pharmacy partner and delivered directly to your home – covered under the Medicare Hospice Benefit at no additional cost to your family. 

There will also be what is often called a “comfort kit” or “emergency medication kit” left at your home. This is a small supply of fast-acting medications that a nurse can authorize by phone in an urgent moment. open or drive anywhere in the middle of the night when your loved one is in distress.

Medical equipment is ordered and typically delivered within 24 hours of enrollment. Depending on your loved one’s needs, this may include:

• A hospital bed for easier positioning and caregiver access
• A wheelchair or bedside commode
• An alternating pressure mattress to prevent pressure sores
• Oxygen equipment is needed for breathing comfort
• A bedside table, bed rails, or other safety items

All covered equipment is identified during the initial assessment and coordinated directly by your hospice team. Your family does not need to source, rent, or pay for any of it separately.

Within 24–48 Hours: Your Full Care Team Is Introduced

Hospice is not a single nurse on a rotating schedule. It is a coordinated, multidisciplinary team – each member with a specific and defined role in your loved one’s care and your family’s support.

In the first 48 hours, you will be introduced to or scheduled with:

• Your primary RN case manager. This is the nurse who will be your most consistent clinical contact throughout your loved one’s hospice journey. They oversee the care plan, coordinate with the rest of the team, and are your first call for clinical questions.
• A hospice aide. Certified nursing aides provide hands-on personal care: bathing, grooming, repositioning, and hygiene assistance. These visits are scheduled based on your loved one’s needs and typically begin within the first two to three days.
• A licensed social worker. Your social worker helps the family navigate the emotional, practical, and logistical dimensions of this time – advance care planning, family communication, community resources, insurance questions, and the weight of everything you’re carrying. They are often one of the most valued members of the team.
• A chaplain. Spiritual care is offered to every patient and family regardless of religious affiliation. Your chaplain provides presence, comfort, and support that honors your loved one’s personal beliefs and traditions. This is not about religion – it is about meaning, peace, and what matters most.
• A volunteer coordinator. Trained hospice volunteers can provide companionship, respite for family caregivers, and light assistance. Your team will discuss how volunteers can best support your situation.

To see the full breakdown of every role on the team, visit: Hospice Care Team

The Care Plan: Built Around Your Loved One, Not a Template

By the end of the first 48 hours, a formal, individualized plan of care has been established. This document drives every clinical decision and visit schedule going forward. It includes:

• Current diagnosis and prognosis
• All active symptoms and how they will be managed
• Medication orders and administration instructions
• Visit frequency for each member of the care team
• Goals of care as expressed by your loved one and family
• Any specific cultural, religious, or personal preferences to be honored

The care plan is not static. It is updated continuously as your loved one’s condition changes. Your primary nurse reviews and adjusts it at every visit. The goal is always the same: your loved one’s comfort, dignity, and quality of life – as defined by them.

For a broader look at how care evolves, read: What to Expect

What Families Are Responsible for in the First 48 Hours

Very little, by design.

Your hospice team handles the clinical coordination, the pharmacy, the equipment, and the scheduling. What helps most during this window is being available to answer questions from the intake nurse, having a list of your loved one’s current medications ready, and making sure someone at the home is present for equipment deliveries.

Beyond that, your job in the first 48 hours is to be with your loved one.

A few things that are worth doing when you have the mental space:

• Save the 24/7 nurse line in your phone. You should never hesitate to call. There are no questions too small. At James River, that number is (855) 415-5744, available around the clock, including nights, weekends, and holidays.
• Let the social worker help you. The logistical and emotional load on family caregivers in these early days is real. Your social worker is there specifically to lighten it. For more on the support available to you, visit our Family and Caregiver Support page.
• Ask every question you have. No question is too basic or too difficult. The first 48 hours are the time to understand exactly what your team will do, when they will visit, and what to do in every scenario you can think of.

How James River Home Health & Hospice Approaches Enrollment

James River Home Health & Hospice has been serving Virginia families since 2013. ACHC-accredited and available 24 hours a day, 7 days a week, our team is built around one standard: the first 48 hours should leave your family feeling supported, informed, and less alone than you were before you called.

We serve communities across Virginia, including Richmond, Fredericksburg, Winchester, Lynchburg, and throughout our full service area. If your loved one is in a private home, an assisted living community, or a skilled nursing facility, our team comes to them.

If you are thinking about hospice for a loved one and want to understand what the process looks like before making any decisions, call us. There is no obligation and no pressure – just a direct conversation with someone who can help.

Call (855) 415-5744 anytime, or contact our team here.

Frequently Asked Questions

• How soon after enrolling in hospice will someone come to the house? In most cases, a registered nurse completes an initial assessment visit the same day or within hours of enrollment being confirmed. Urgent comfort needs are addressed immediately. Equipment and medication delivery typically follow within 24 hours.
• Do I need to do anything to prepare before the first hospice visit? Having a list of your loved one’s current medications available is helpful. Beyond that, your hospice team handles the coordination. Make sure someone is home for the intake nurse visit and for equipment deliveries.
• What if my loved one’s pain is not controlled in the first 24 hours? Call your hospice nurse line immediately. Pain management is the first clinical priority, and your nurse has the authority to adjust medications quickly. You should never wait and hope symptoms resolve on their own.
• Who do I call if something happens in the middle of the night? Your hospice provider’s 24/7 nurse line. At James River, that number is (855) 415-5744. A registered nurse is available at any hour to advise, authorize comfort medications, or dispatch someone to your home.
• Can I change anything about the care plan after it is set? The care plan is a living document and is updated at every visit. If your loved one’s needs, preferences, or condition change, your nurse case manager adjusts the plan accordingly. Nothing is locked in. Your family’s input guides every revision.
• What does hospice actually cover in the first 48 hours under Medicare? Under the Medicare Hospice Benefit, covered services in the first 48 hours typically include the initial assessment visit, all medications related to the terminal diagnosis, medical equipment and supplies, and the beginning of care team visits. There are no co-pays for covered hospice services for Medicare beneficiaries.