Live Comfortably - February 12, 2025
By Kathie Miller
For patients and families facing serious medical challenges, deciding when to begin hospice care can feel overwhelming. But starting the conversation early is one of the most thoughtful ways to ensure comfort and dignity for your loved one. Planning ahead gives everyone the chance to prepare, find alignment and make decisions with care rather than urgency. Revisiting the plan regularly and understanding your options can ease the transition and provide meaningful support when it’s needed most. When it comes to hospice care, sooner is often better than later — it’s a step toward peace, not just for the patient, but for everyone involved.
This article will cover common indicators of when it’s time to initiate hospice care services, but we invite you to reach out to our compassionate Goodwin Hospice team with any questions at 703.578.7108 or HospiceReferrals@GoodwinLiving.org.
Deciding to initiate hospice care isn’t solely up to the patient or their family. It requires certifications from medical professionals. Doctors must confirm the three following eligibility conditions. The patient must have:
While these certifications are essential, families often play a critical role in starting the conversation. Loved ones who see the patient daily may notice changes — physical, emotional, or otherwise — that suggest it’s time to explore hospice care. Doctors and medical teams will provide guidance and recommendations, but families often recognize more subtle signs that hospice care may soon be needed.
If you’re noticing certain changes in your loved one’s condition, it may be time to start a conversation about hospice care. These key signs are often indicators that it may be time to start hospice. If one or more of these is present, it’s worth involving your family and reaching out to a hospice provider for guidance.
A lack of appetite, weight loss, or trouble swallowing are common signs that the body is having difficulty maintaining itself. Hospice can provide nutritional support and comfort measures tailored to these challenges.
If your loved one is withdrawing from friends, family, or activities they once enjoyed, it could be a sign they are focusing inward as their energy wanes. Hospice care can provide emotional and spiritual support for both the patient and their loved ones during this time.
Increased nausea or vomiting that is difficult to control can be a signal that illness is advancing or that other treatments are no longer effective. Hospice care can provide specialized symptom management to ease discomfort and improve overall quality of life.
Worsening or persistent pain that becomes hard to manage may indicate that illness is progressing. Hospice care specializes in advanced pain management, ensuring your loved one is as comfortable as possible.
If your loved one is sleeping significantly more or experiencing extreme fatigue, it may be a sign their body is conserving energy as the illness progresses. Hospice care focuses on comfort and support, helping to manage energy levels while providing compassionate care.
Increased infections can indicate that the body’s ability to fight off illness is waning. Hospice care can help manage these infections with a focus on comfort and symptom relief.
Unexplained weight loss can be a sign that the body is struggling to maintain itself, often due to the progression of illness. Hospice care can offer nutritional support and comfort measures to address this symptom.
The following signs are more severe and clear indicators of when to start hospice. While having one or two of these symptoms on their own might not mean it’s time for hospice, experiencing several of them suggests the time to reach out to a hospice provider for more information is now. It’s always better to address these issues sooner rather than waiting, so that your loved one can avoid unnecessary suffering and receive the comfort-focused care they deserve.
A complete loss of appetite often signals that the body is nearing the end of its ability to function normally. Hospice care can help manage this symptom by offering alternative ways to provide comfort, focusing on hydration and nutrition that supports quality of life
If your loved one is becoming less responsive to their environment or to those around them, it may indicate that their condition is advancing. Hospice care can provide emotional and physical support during this time, ensuring that your loved one feels comforted and surrounded by care
Frequent hospital or ER visits in a short span can indicate that the patient’s condition is worsening or that treatments are no longer effective. Hospice care offers an alternative by managing symptoms at home, reducing the need for emergency interventions and providing consistent, compassionate support
Frequent falls over a short period may signal a decline in physical strength or coordination, often due to the progression of illness. Hospice care can assist by addressing safety concerns, managing pain, and offering support to help prevent further incidents.
Significant changes in physical appearance, such as pale or blotchy skin, a gaunt appearance, or a noticeable loss of muscle mass, can indicate that the body is no longer functioning at its usual capacity. Hospice care focuses on comfort and dignity, providing support to manage these changes.
Frequent or persistent infections that don’t improve with treatment can signal that the body’s ability to fight illness is weakening. Hospice care can help manage these infections with a focus on comfort and preventing unnecessary suffering.
If your loved one is experiencing increasing difficulty with movement, such as trouble walking, getting out of bed, or performing daily tasks, it may be a sign that their condition is progressing. Hospice care can assist with mobility challenges, offering support to ensure comfort and help maintain as much independence as possible.
Difficulty of speaking, slurring words, or an inability to communicate clearly may indicate that your loved one’s condition is advancing. Hospice care can provide support through alternative communication methods, ensuring that your loved one’s comfort and dignity are prioritized.
If your loved one is sleeping much more than usual or is unable to stay awake for extended periods, it may be a sign that their body is conserving energy as the illness progresses. Hospice care focuses on ensuring comfort and managing fatigue.
Increased restlessness or confusion can signal that the illness is progressing or that your loved one is struggling with difficult symptoms. Hospice care offers comfort and stability, helping to manage these changes with a focus on both physical and emotional support
Experiencing shortness of breath even while at rest can indicate that the body is having difficulty maintaining normal functions. Hospice care specializes in managing breathing difficulties, offering relief and ensuring your loved one remains as comfortable as possible.
When symptoms like pain, nausea, or fatigue become overwhelming and are no longer manageable with standard treatments, it may be time to consider hospice care. Hospice focuses on providing relief from these unbearable symptoms.
Each disease has specific signs to start hospice. While doctors typically explain these markers, patients may not fully recognize them, often due to reluctance or confusion about their condition. Family members may need to step in and consult with the doctor to help the patient understand when hospice care is appropriate. Below, we cover common diseases and their progressions, offering a guide to help families make informed decisions about when to consider hospice care.
When metastatic cancer is diagnosed, and the patient’s condition continues to worsen despite treatment, with curative options no longer being pursued, they may become eligible for hospice care.
Dementia or Alzheimer’s patients who experience a significant decline in cognitive function, have trouble swallowing or are diagnosed with pneumonia or sepsis may qualify for hospice care.
Stroke patients may be eligible for hospice if they experience a substantial decline in functional abilities, recurrent complications, and are largely confined to bed or a chair.
In Congestive Heart Failure or cardiopulmonary disease, signs that hospice may be appropriate include specific structural or functional impairments, poor response to treatments like diuretics and vasodilators and a noticeable decline in overall endurance.
Hospice eligibility for COPD or other cardiopulmonary diseases may be indicated by severe respiratory symptoms, frequent exacerbations, and persistent dyspnea or chest tightness.
Liver disease patients may be eligible for hospice care if they experience recurrent variceal bleeding, hepatic encephalopathy, peritonitis, and other complications.
A patient in end-stage renal failure who chooses to discontinue dialysis and experiences a significant decline in kidney function may qualify for hospice care.
Patients with neurological conditions such as non-Alzheimer’s dementia, Parkinson’s disease, MS, ALS and Huntington’s disease may be eligible for hospice care when they experience structural or functional impairments, limitations in daily activities, and increasing pain.
For HIV/AIDS patients, eligibility for hospice care may be indicated by low CD4 counts, high viral loads and widespread weakness.
Planning for hospice care ahead of time reduces stress and ensures that decisions are made with clarity and confidence. It allows for open discussions, honors the patient’s wishes, and helps families navigate the transition smoothly when the time comes. Having a plan in place makes it easier to focus on comfort and quality of life, rather than scrambling to make decisions in a crisis.
No, this is a common misconception about hospice care. Hospice isn’t only for the very final days or weeks. But patients may become eligible for hospice care once a physician has determined their life expectancy is six months or fewer. And studies even suggest that beginning hospice care earlier in the end-of-life process can lead to better experiences.
For more information on eligibility requirements for hospice, read our blog: Who is Eligible for Hospice Care?
Starting hospice care early ensures that patients receive the full benefits of comfort-focused care, symptom management and emotional support. It also allows for better planning, more time to address needs, and reduces the risk of unnecessary suffering. By initiating hospice early, families can also spend more quality time together.
Many delay calling hospice out of fear, hope for recovery, or uncertainty about what hospice care truly involves. It can be hard to accept that treatment options are limited, and the stigma or impression of giving up can make decision makers feel open to criticism.
However, hospice care offers valuable support long before the end, focusing on comfort and quality of life. Waiting too long can lead to unnecessary pain and missed opportunities for meaningful time with loved ones. Starting hospice early can provide peace and comfort when it’s needed most.
Once hospice care begins, the focus shifts to providing comfort, managing symptoms, and improving quality of life. A team of professionals — including doctors, nurses, social workers, and counselors — will work closely with the patient and their family to create a personalized care plan. This team provides ongoing support, ensuring that physical, emotional and spiritual needs are met. Family members also receive guidance and assistance, helping them navigate this challenging time with empathy and care.
Hospice care is voluntary, and patients (or their POA) can stop it at any time if they feel it no longer meets their needs or want to explore other treatments. Discontinuing hospice is a simple process, involving clear communication with the hospice team, who will help coordinate a smooth transition, including necessary treatments and emotional support.
When it comes to hospice care services, Goodwin Hospice rises above the rest. Our mission is simple: provide the highest-quality, patient-centered care to our hospice patients and their loved ones. And it shows — Goodwin Hospice received a four-star rating from Medicare.gov in the February 2024 quarterly Care Compare Care Quality Report. As the highest rating in the hospice category for Northern Virginia, we’re proud to offer this level of end-of-life care. We’ve provided it to our residents for more than two decades, and we have offered it to our community, including Alexandria, Arlington, Fairfax and Falls Church, since 2016. Another consideration for patients in Northern Virginia is that we do not turn away patients who lack financial resources, one of many advantages to our non-profit hospice care model.
Goodwin Hospice is able to deliver the most compassionate care available because of our top-ranked team of Medicare-certified hospice care providers with more than 50 years of experience. From physicians, nurse practitioners, and registered nurses to licensed clinical social workers, spiritual counselors, and bereavement counselors, our team delivers comprehensive care where and when you need it most. And we couldn’t do it without our wide network of dedicated hospice aides and volunteers to support the rest of the team. It’s a team that’s unmatched, and patients can tell they’re receiving only the best in hospice care.
Because Goodwin Hospice believes everyone has the right to die with dignity and comfort, we go above and beyond to deliver exceptional end-of-life care. In addition to pain management and symptom control, personal care, social work services, counseling, spiritual support, and 24/7 on-call nursing support, Goodwin Hospice offers a bundle of complimentary compassionate services. These include our friendly visitor volunteers, pet companionship, end-of-life doulas, end-of-life massage therapy and visits from Threshold Choir singers. Hospice services include 13 months of bereavement following the loss of a loved one. This benefit is structured in order to provide support through the anniversary of the person’s death.
If you have any questions, we’re here to help at any time. Feel free to contact us at 703.578.7108 or HospiceReferrals@GoodwinLiving.org to ask any questions or get more details about Goodwin Hospice.
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