Can a person be placed on hospice without a physician's consent?

In some but not all instances do you need a doctors recommendation for hospice care.
Back in July 2018 I took it upon myself to call hospice for an evaluation for my husband without his doctors knowledge and they came out and did an evaluation in which at that time he only qualified for their palliative care, which I wasn't interested in.
Ironically he went under hospice care in Nov. 2018 after almost dying from aspiration pneumonia and remained under their care until his death in 2020.
If both your parents are now under hospice care it means that they both had to qualify for their care, which apparently they did, so be grateful that they now have extra sets of eyes on them and that they are being taken care of and kept comfortable.
So to answer your question, yes someone can be placed under hospice care without physicians consent.

The Hospice doctor after reviewing medical records could confirm that the patient is Hospice eligible.
When I stopped in at the Hospice I used for my Husband the admitting nurse made a phone call and that was pretty much it.
If your siblings signed a release the Hospice could have obtained the information from the doctors office and not informed your parents doctor that they were going to be placed on Hospice. Simple reason for that is your sister had not yet signed the document that officially admitted them to Hospice.

Is your sister POA for your parents? If so then this would be acceptable.
If not and your parents are not competent to sign for themselves then it might be a bit premature.
If your sister is not POA (or any of the other siblings) this could be problematic. You, if you wanted to file for Guardianship.

All that said and because it is me replying...and I will say I am VERY pro Hospice.
If your parents are eligible for Hospice I think there are many advantages to Hospice.
If your parents are home there will be a Nurse that will come each week to check on them. There will be a CNA that will come 2 or 3 times a week to give them a bath or shower. All the medical supplies needed will be delivered to the house. Any medications will be delivered to the house. All the incontinent supplies including gloves, ointments, barrier creams, absorbent pads will be delivered. Any equipment commode, toilet seat risers, wheelchair, hospital beds, Sit-to-stand or Hoyer Lift will all be delivered. And each patient is eligible for about 1 week of Respite each year and your sister can request a Volunteer that can come in and sit with them or do some light housework if that is needed. Other members of the "team" are Social Worker, Chaplain and often there are other Therapies like art, music, pet that you can request.
I honestly see no downside to having Hospice come in and provide service.

Your sister did not need her parents PCP to agree or order Hospice. All Sis had to do is call a Hospice provider, have your parents evaluated and approved and the Doctor affiliated with the Hospice could sign off.

I discussed Hospice with the Head Doctor at Dana Faber and he saw my brother and agreed it was time to Bring Hospice in . Once the cancer went to his brain. I called Hospice and made an appointment . Then I Talked with the Head Psychiatrist at Brigham and Woman and Dana Faber - Dr. Peteet we spoke for a Hour . When It was time to administer Morphine this was discussed with the Nurses at Hospice and the social worker at the NH . I feel Its best to have back up and have expert Opinions .

Yes, it's legal. There comes a time when treatment needs to stop with elders. The indignity of being poked and prodded in useless trips to ERs where there is a 4 hour minimum stay, or worse yet, when they're admitted and come out in worse shape than when they went in, with hospital delirium and more issues than Newsweek. Elders of advanced age should be allowed to live in comfort and ease during their final days, weeks, months or even years of life left on Earth. Causing them trauma in a futile attempt to ward off the inevitable is not a great idea by most people's standards.

I didn’t have your situation. I initially inquired about hospice care with my mom’s doctor. Mom started off with palliative care, then progressed into hospice.

Once a person reaches a certain point in their lives, hospice care makes the most sense. People who have progressive and incurable diseases like my mom had (Parkinson’s disease) are not going to improve. The best thing that we can do for them is to keep them comfortable.

Grandma1954 July 28, 2023 3:30pm
Oreohun85,
If you made the comment that Hospice was going to provide 12 hours a day of Nursing care that would not have been a service covered by Medicare, Medicaid or other Insurance it would have been something that would have had to come out of pocket as an expense.
Hospice will not provide that type of care.
It may have been a Home Care Agency affiliated with the Hospice but again that would have been an out of pocket expense.

Interestingly, my Dad's doctor was also the hospice doctor.

I don't see a way to edit my answer--I meant that my Mother's physician was the hospice physician too, not my Father's physician. My Father isn't quite at that stage yet.

My mother is on hospice only because she is getting additional services that we would have had to pay for any other way. We now have another aide so that she now has 11 hours of coverage Monday thru Friday. The nurse comes once a week to check her out.

My mother had a UTI last month, I brought her to her doctor, there was no problem with doing this.

I met with the social worker last week, I had some concerns about hospital stays because we are trying to get my mother admitted to a nursing home. She told me you can drop out any time.

Thus far I view hospice positively. I am glad we have it in place. No complaints from me.

It doesn't have to be THEIR doctor. My dad was referred to hospice by an ER doctor.

I was always under the impression that hospice care was for those who were thought to have six months or less left to live.

My mom was put on hospice quite a few times for 3 years before she passed. I’m pretty sure it was the home health care team that ordered it for her

In NY this can be done. We did it with my mother. She had an appointment with her PCP last week. I told him that we did this, he said many people do this to get services that they would otherwise have to pay for. He did not need to provide authorization.

In Massachusetts you don't need your GP's permission. Although my Mom was placed on hospice by her GP while still in the hospital (10 years ago). Me and my husband took primary care of her (my husband is a Paramedic) so in many cases that helped her and me to understand some of the stages she was experiencing. We had to pay to have a PCA come in for a hour each day just to give me a little downtime. I wish we could have been eligible for more help but we weren't because they said Mom made to much money 😕. Trust me she didn't make all that much SS and had little in the bank. Sorry I went off track there! I wish you blessings and prayers 🙏 it's very difficult being the caregiver but worth it, at least for me, I wouldn't have done it any other way however you must take care of yourself as well.

The patient and/ or the POA for the pt. have " patient rights" which include the right to choose, to say yes or decline any medical care . PT and or POA have the right to request hospice care. Often some physicians are reluctant to offer or even make the pt and family aware that hospice is a choice; this is often at the detriment to the pt. Patients and families have the right to request and be admitted to hospice care if the hospice evaluation deems the pt. " Hospice appropriate".

The hospice clinical director and hospice medical director physicians work with the PT and or family POA and any other needed physicians and provide directions re communication with any necessary other physicians during the hospice assessment and admit and through out the hospice care.

You never need a physicians permission, you need a physician order however the hospice medical director can write the order, it does need the primary’s agreement.

I noticed that several replies mention that the PCP was also Medical Director of a Hospice. FYI for those readers who may not know; Yes, practicing physicians can and are at their choice and agreement with a hospice also the Medical Director for a hospice. Hospice services seek out physicians with a " private practice" to be a Hospice Medical Director as this gives the Hospice a direct link to pt referrals at times. The physician serving as the Hospice Medical Director usually receives financial compensation from the hospice.

And, many patients entering into hospice services choose to make the hospice medical director ( MD) their physician of record directing their care from that point forward. Conferring with pts PCP or other physicians assoc with the pt is done at pt/ POA request to keep that physician informed if he/ she wants.

Hospice is an specialty care in the healthcare systems for or and family choice when aggressive treatment is no longer available or pt wants to discontinue such aggressive treatment. Hospice services should be viewed by the medical establishment and community as a specialty just like all other medical specialists such as cardiac, neurology, urology, oncology, orthopedic etc etc specialties.

Hospice is the specialty for compassionate care for pts with a life limiting illness who have exhausted all aggressive treatments or chosen to forgo aggressive treatments. Hospice cares for not only the PT but also the family with many specialty professionals on the Hospice team. Note that " hospice is care for life limiting illnesses" it is not about " dying"; it is about "quality of life" in the midst of a life limiting illness for pt. and family toward as a peaceful EOL . Everyone would do well to educate selves about hospice ; the learning curve is still very steep in communities.

You Need to speak to your sister about her decision . No One is locked into Hospice - you can leave anytime .

Oreohun85: Although it's helpful to have the physician's guide, it is not 'the gospel' as far as hospice goes.

A doctor needs to be involved to place anybody on hospice since there are general rules about hospice:
1 - the person is expected to live 6 months or less,
2 - the person agrees to shift from curing disease (or has an incurable disease) to maximizing comfort,
3 - the doctor will need to prescribe medications for comfort (usually pain medications), and
4 - the doctor will need to prescribe "hospice" for any hospice agency to send personnel to provide care (and get paid by insurance company).

Ask your siblings who the doctors are that are involved in your parents care. Try to contact these doctors and ask for a meeting with the family so information can be shared.

When a parent dies who is being cared for by the health care proxy aka the oldest brother. Is the health care proxy required to notify all other family members of their mothers death?

Hospice requires physician referral. However, that MD need not be the MD of the patient. It can be any MD who has access to the patient's history and wishes for end of life care. So that it can be the recommendation of a hospitalist in the hospital. A rehab doctor. And from what I can research even the hospice MD themselves can review the case history and recommend Hospice.
The only stipulation for Medicare coverage is that the expectation of life if 6 months or less. That the patient or patient's POA, MPOA or next of kin operating in the absence of parent's competency agrees with MD assessment and is familiar with the parent's wishes for comfort care at the end of life.

There is a POA involved here, I assume.
Discuss with that POA.

If you suspect that your parents do not want hospice care, that your parents doctors are not aware that they have hospice care, and that someone in your family has ordered it in an attempt to usher them to an early death, then take your evidence of this to an attorney, is the only thing I can suggest.

If a Hospice is involved, and you are a family member, it is my experience that they will tell you which MDs approved your parents for hospice care.

This is a post from July 2023. OP asked this one question and has not returned.