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Hospice Care/Agreeing to hospice while in hospial


My mother was in in hospital for the second time in a month for phenomena, she had COPD and CHF. we as a family including my mom agreed it was time to call hospice due to the fact she was DNR, we thought it would be good for the comfort measures. The Dr. agreed but wanted to finish up on 4 more treatments of IV antibiotic, that took 4 days. One the second day I believe my mom suffered a heart attack, she was in a lot of pain and the only thing they gave her was otc only when I asked for them. I finely asked for something stronger because she was suffering. On the forth day the doc never wrote the order for the antibiotic, and they proceeded with her release, she made it home and died 4 hours later with the comfort of Hospice. Why didn't hospice step in sooner, is it because of the hospital, if that is the reason why didn't they (the hospital) just send her home on the 3 so she wouldn't have to suffer.

Dear Joan,
I feel the sadness you are written in your inquiry.  I hope I can provide some type of answer for you.

In the hospice community I practice, a referral has to written by a physician when the patient is the hospital.  The family can contact hospice themselves and ask for an information visit but will still need the doctor to write a referral order.   

I sounds as if the doctor felt the antibiotic would be helpful and offer a better quality of life.  Unfortunately as you have stated this did not occur.   The doctor is the one that writes the orders for pain medication.

The nurses can participate in the role of patient advocate. In this case to ask for hospice referral and at least have hospice visit for an informational visit. Second the nurse can advocate for the patient by letting the doctor know the medications ordered were not helping with the pain.   

I have no answer as to why your mother was not sent home on day 3, once again the doctor has to write a discharge order.

You can discuss these concerns with the unit manager with the purpose of bringing awareness to the manager of your concerns and perhaps this would help prevent in some fashion, other families from having this experience.

If you have further questions please feel free to get back with me.

Hugs to you at this chapter of your life.

Hospice Care

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Jan Reeves


Hospice care is care for the end of life and dying patient and family. Hospice provides support with focus on quality of life issues. End of life does not mean the patient will have pain. Pain is one of several symptoms hospice will focus on for quality of life for the time reamining. Hospice takes the journey along with the patient and the family.


I have been a hospice nurse for 17 years. I teach basic pain for hospice staff and advanced pain class for hospice nurses. I am a bedside nurse and visit patients in their home of choice or nursing home.

Hospice Palliative Nursing Association Internation Association of Hospice and Palliative Care

in process

I have a BSN and am certified in hospice and palliative care for 7 years.

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Bloomington Hospital Research Fellow

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