Home Hospice Care in Minnesota: A Step-by-Step Guide

Beginning the Journey: Initiating Care and Referrals

The hospice conversation often emerges when curative treatments no longer offer meaningful benefit or align with the patient’s wishes, prompting a transition toward comfort and life quality.

Physician Partnership

A physician typically serves as the gateway to hospice care, identifying candidates based on diagnosis and prognosis. Their certification of terminal illness constitutes a fundamental eligibility requirement, confirming both the condition and the six-month prognosis if the disease follows its expected course.

Diverse Referral Pathways

While physicians frequently initiate the referral process, multiple avenues exist:

• Hospital discharge planning teams
• Nursing facility staff members
• Social workers and case managers
• Various healthcare providers
• Family members advocating for their loved one
• Patients themselves seeking comfort-focused care

Many hospice organizations explicitly welcome self-referrals, though physician certification remains necessary for formal admission. Providers typically offer specific contact information for referrals through their websites and informational materials.

Making First Contact

The process typically begins with a direct phone call to a hospice agency or through their online portal to:

• Discuss available services
• Review eligibility requirements
• Initiate the admission process

Many agencies prioritize responsive care, with some offering 24-hour availability for urgent situations and same-day emergency admissions when circumstances require immediate intervention.

Formalizing the Commitment: Election and Admission

Once eligibility has been established and the patient chooses hospice care, a formal election process begins:

The Hospice Election Statement

This crucial document serves as the official entry point to hospice care. The patient (or authorized representative) must sign this statement, which:

• Identifies the specific hospice provider chosen to deliver care
• Acknowledges understanding that hospice focuses on palliative rather than curative treatment
• Recognizes that certain Medicare/Medicaid benefits related to curative treatment of the terminal illness will be waived
• Specifies the care start date (which cannot precede the signature date)
• Includes the patient’s or representative’s signature

Provider Obligations During Admission

The selected hospice agency must fulfill several responsibilities during this transition:

• Thoroughly explain hospice care’s nature and available services
• Clearly communicate both elected benefits and those being waived
• Inform the patient or representative of their rights, typically providing the Hospice Bill of Rights
• Provide a copy of the signed election statement to the patient/representative
• Retain the original document
• Promptly notify relevant parties including the attending physician and, for Medical Assistance recipients, the local county human services agency
• Submit documentation within required timeframes (within two calendar days for MA recipients)

The Election Statement transcends mere paperwork—it represents the legal mechanism that activates hospice benefits under the patient’s insurance coverage. It documents informed consent and initiates the specific coverage parameters associated with hospice care.

Creating the Roadmap: Assessment and Care Planning

Following election, the hospice team collaborates with the patient and family to establish a comprehensive care framework:

Comprehensive Assessment

The interdisciplinary team conducts a thorough evaluation encompassing:

• Physical condition and symptom burden
• Pain management needs
• Psychosocial circumstances
• Spiritual preferences and needs
• Functional capabilities
• Home environment considerations
• Family and caregiver support systems

Developing the Plan of Care

Before services formally commence, the team creates an individualized, written Plan of Care through collaboration between:

• The hospice interdisciplinary team
• The hospice physician/medical director
• The patient’s attending physician (if continuing involvement)

This detailed plan outlines:

• Specific services required
• Visit frequency for various team members
• Care goals (primarily symptom management and life quality)
• Medication orders and management
• Equipment and supply requirements

This document serves as the central reference guiding all aspects of hospice care delivery.

Care Coordination

A designated Registered Nurse typically assumes responsibility for coordinating the implementation and ongoing management of each patient’s Plan of Care, ensuring consistency and continuity.

Maintaining Choice: Provider Changes and Revocation Options

Patient autonomy remains paramount throughout the hospice experience:

Changing Hospice Providers

Patients retain the right to change their designated hospice provider once during each benefit period:

• Once during the initial 90-day period
• Once during the subsequent 90-day period
• Once during each 60-day renewal period thereafter

This process requires:

• Signing a specific statement indicating the change
• Specifying the effective date
• Submitting documentation to both the current and newly selected hospice

Revoking Hospice Care

Patients maintain the right to discontinue hospice care at any point by:

• Signing a revocation statement provided by the hospice
• Specifying the effective revocation date

Upon revocation:

• The hospice benefit terminates
• The patient regains eligibility for standard Medicare/Medicaid benefits previously waived
• The hospice must notify relevant agencies within two business days for MA recipients
• Patients may re-elect hospice care later if they continue meeting eligibility criteria

This structured process ensures that Minnesota residents can access appropriate hospice care while maintaining their autonomy and decision-making authority throughout this significant healthcare transition.