Hospice referral
Formal Definition
A formal referral to hospice care, which provides intensive comfort-focused interdisciplinary care for patients with a terminal prognosis of 6 months or less if the disease runs its normal course; covered under the Medicare Hospice Benefit, requiring physician certification of terminal prognosis and patient/family election to forgo curative treatment in favor of comfort-focused goals.
How It's Used on the Ward
"Referring to hospice" or "appropriate for hospice" or "six-month prognosis" — the referral that shifts care from cure-focused to comfort-focused, often delayed too long.
Example
""76-year-old with stage IV pancreatic cancer, declining performance status, no longer a surgical or chemotherapy candidate: appropriate for hospice referral. Palliative care team will help with the conversation; Medicare Hospice Benefit provides 24/7 nurse access, medications, and aide services at home or in a facility.""
Clinical Context
Medicare Hospice Benefit: requires two physicians to certify prognosis ≤6 months; patient must elect hospice (waiving Medicare Part A for curative treatment of the terminal diagnosis). Hospice can be revoked at any time. Hospice vs palliative care: palliative care is available at any stage of illness alongside curative treatment; hospice is for end-of-life when curative treatment is discontinued. Levels of hospice care: routine home care (most common), continuous home care (crisis management), inpatient respite care, general inpatient care (symptom crisis). Prognostication tools: PPS (Palliative Performance Scale), FAST score for dementia, NYHA IV heart failure criteria. Hospice is persistently underutilized — median enrollment is 18 days; patients and families often wish they had enrolled sooner. Hospice does NOT mean giving up treatment for non-terminal conditions (e.g., antibiotics for a UTI are still appropriate).