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Breakthrough Pain in Hospice: How Rescue Doses Keep Your Loved One Comfortable

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Breakthrough pain is a sudden, temporary spike in pain that occurs even when a patient is already on scheduled pain medication. In hospice care, rescue doses – small, fast-acting doses of medication are prescribed specifically to address these episodes. 

This guide explains what breakthrough pain looks like, how rescue doses work, when to use them, and what families in Burbank and Los Angeles County should know before a crisis happens.

What Is Breakthrough Pain in Hospice?

Most hospice patients receive around-the-clock pain medication on a scheduled basis. That baseline dosing is designed to control what clinicians call “background pain”- the persistent, ongoing discomfort that comes with a serious illness.

Breakthrough pain is different. It’s a sudden flare of pain that breaks through the protection that scheduled medication provides. These episodes can come on quickly, often within minutes, and may last anywhere from a few minutes to an hour. They can happen during movement, during personal care, or entirely without warning.

For families caring for a loved one at home, witnessing breakthrough pain can be frightening- especially if they don’t know what to do. That’s exactly why hospice teams send families home prepared.

What Are Rescue Doses?

A rescue dose is a separately prescribed, fast-acting medication given specifically for breakthrough pain. It is not a substitute for the regular pain regimen- it is a safety net layered on top of it.

Your loved one’s hospice physician or nurse practitioner will calculate the rescue dose based on their total daily opioid requirement, typically prescribing 10–15% of the 24-hour total as a single as-needed dose. The medication is usually the same drug as the long-acting medication, just in an immediate-release form.

Journey Palliative and Hospice includes rescue medication in every personalized, specialized pain management plan. Medications are delivered directly to the home, and our team ensures caregivers know exactly how and when to use them before a crisis occurs.

Types of Breakthrough Pain

Understanding the type of breakthrough pain your loved one experiences helps the care team optimize their medication plan.

  • Spontaneous (idiopathic) pain occurs without a clear trigger. It is unpredictable and often associated with nerve-related conditions or advanced cancer.
  • Incident pain is triggered by a specific activity- repositioning, bathing, transferring from bed to chair, or even coughing. Because it’s predictable, the care team can time a rescue dose 20–30 minutes before the activity to head off the pain.
  • End-of-dose failure happens when the long-acting medication wears off before the next scheduled dose. If your loved one is consistently in more pain in the hours before their next dose, that’s a signal the current regimen needs adjustment- not a reason to simply increase rescue dose frequency.

Your hospice nurse documents these patterns and adjusts the care plan accordingly. If you’re noticing a trend, note the time of day, what was happening beforehand, and how long the episode lasted. That information directly shapes the medication plan.

When to Call the Hospice Team

Rescue doses are effective for most breakthrough pain episodes, but there are situations where you should call your hospice nurse rather than- or in addition to- giving the medication:

  • The rescue dose was given, and pain did not improve within 30–60 minutes
  • Your loved one is having more than three or four breakthrough episodes per day (this signals the baseline needs adjusting)
  • The pain episode is unusually severe or different in character from prior episodes
  • Your loved one is having trouble breathing, appears confused, or cannot respond normally
  • You are uncomfortable with the situation for any reason

Frequent breakthrough episodes are not a failure of the rescue dose- they are clinical information. Your care team uses that data to refine the pain management plan so your loved one is more consistently comfortable throughout the day.

Complementary Approaches Alongside Rescue Medication

Medication is the most effective tool for breakthrough pain, but it works best as part of a broader comfort strategy. The Journey Palliative and Hospice care team also incorporates:

  • Positioning and repositioning: Small adjustments in body position can significantly reduce incident pain. Our home health aides and in-home caregiving team helps families learn proper repositioning technique.
  • Physical therapy: Gentle movement and physical support reduce pain caused by immobility and muscle tension. See how our team approaches this in The Role of Physical Therapy in Hospice Care.
  • Relaxation and distraction: Breathing techniques, music, and calming touch can reduce the perception of pain- particularly for anxiety-linked breakthrough episodes.
  • Massage and complementary therapies: Part of Journey’s individualized approach to pain management when clinically appropriate.

How Journey Palliative and Hospice Manages Breakthrough Pain in Burbank and Los Angeles County

Pain management in hospice is never one-size-fits-all. Journey Palliative and Hospice serves patients across Burbank, Los Angeles County, and surrounding communities with a multi-disciplinary team that includes registered nurses, a hospice physician, social workers, chaplains, and home health aides- all coordinating around a single goal: keeping your loved one comfortable.

Every patient receives a personalized plan that accounts for their diagnosis, comorbidities, current medications, and preferences. That plan is reviewed continuously, adjusted as symptoms evolve, and communicated clearly to family caregivers so no one feels unprepared.

Families who are unsure whether their loved one is ready for hospice- or who are weighing the decision between hospice and continuing treatment- can review our recent post, Hospice vs. Continuing Treatment: How Families Decide.

Frequently Asked Questions

  • How often can a rescue dose be given?
    • Rescue doses are typically prescribed with a minimum interval between doses- often every one to four hours as needed. If breakthrough pain is occurring more than three to four times per day, that is a signal that the patient’s scheduled medication needs to be adjusted. Frequent use of rescue doses should always be reported to the hospice nurse.
  • What should I do if the rescue dose doesn’t work?
    • If pain has not improved 30 to 60 minutes after giving a rescue dose, call your hospice on-call nurse. A single failed dose may indicate the dose needs adjustment, a different route of administration, or that the pain has a different cause than expected. Do not give a second dose without guidance unless specifically instructed by the care team to do so.
  • Does using rescue doses mean my loved one is close to death?
    • Not necessarily. Breakthrough pain can occur at any stage of a serious illness. Using rescue medication as prescribed is a sign that the care plan is being followed, not that death is imminent. If you have concerns about the progression of your loved one’s condition, speak openly with your hospice nurse.
  • Are rescue doses covered by Medicare?
    • Yes. Under the Medicare Hospice Benefit, all medications related to the terminal diagnosis- including rescue dose medications- are covered. This includes the drug itself and delivery to the home. Journey Palliative and Hospice works directly with Medicare to ensure families experience no out-of-pocket surprise for covered medications.

Your Team is Here for You

Breakthrough pain is one of the most stressful situations a family caregiver can face. The difference between feeling prepared and feeling panicked in that moment is education, a written plan, and a care team you can actually reach.

Journey Palliative and Hospice serves families across Burbank and Los Angeles County with around-the-clock nursing support, home delivery of medications, and hands-on caregiver education before you ever need it.

Call us today at (818) 748-3427 or request care online to speak with our team.

What Is Hospice Recertification and Why Does It Happen?

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Hospice recertification is the routine process where a hospice physician confirms a patient still meets Medicare’s eligibility criteria for hospice care. It happens at set intervals, the first two 90-day periods, then every 60 days after, and it does not necessarily mean a patient’s condition is worsening. It simply ensures continued coverage and keeps the care plan aligned with the patient’s current needs.

Why “Recertification” Can Sound Alarming

If you’ve recently heard the word “recertification” from your loved one’s hospice team, it’s natural for your mind to jump to the worst-case interpretation. For many families, hospice already feels like unfamiliar territory, full of new terms, new routines, and new people in the home. Adding a word like “recertification” into the mix can make it feel like something has shifted, or that a decision is being made about your loved one’s future without your input.

Take a breath. In almost every case, recertification is simply part of how hospice care is structured under Medicare. It’s a built-in checkpoint that happens for every hospice patient, on a predictable schedule, regardless of whether their condition has changed.

Understanding what’s actually happening behind this term can take a lot of the anxiety out of the process and help you feel more confident asking questions when your care team brings it up.

How the Hospice Benefit Is Structured

To understand recertification, it helps to understand how Medicare organizes hospice care into what are called “benefit periods.” These are blocks of time during which hospice services are authorized:

  • The first benefit period lasts 90 days
  • The second benefit period also lasts 90 days
  • Every benefit period after that lasts 60 days, and there is no limit to how many a patient can have, as long as they continue to qualify

At the start of each new period, before hospice services can continue, a hospice physician or medical director must certify in writing that the patient still has a life expectancy of six months or less, assuming the illness follows its typical course. This is the “recertification.”

Beginning with the third benefit period, Medicare requires something additional: a face-to-face encounter. This means a hospice physician or nurse practitioner must visit the patient in person before recertifying them, to personally assess their condition and confirm that hospice remains appropriate.

This structure isn’t unique to any one hospice provider. It’s a Medicare requirement that applies across the country, which means every hospice patient on Medicare goes through this same rhythm of certification and recertification.

Learn More About What to Expect When Starting Hospice

Why Recertification Exists in the First Place

It’s worth asking: why does Medicare require this at all? A few reasons sit behind the policy, and most of them are actually protective for patients and families.

  • It keeps the care plan honest and current. Hospice is meant for patients with a limited life expectancy, but the course of an illness isn’t always predictable. Some patients decline steadily. Others stabilize for weeks or months, sometimes due to the comfort and symptom management hospice provides. Recertification gives the medical team a structured opportunity to step back, look at the full picture, and confirm that hospice is still the right fit, or to flag if something has changed.
  • It protects the integrity of the Medicare hospice benefit. Because hospice is a Medicare-funded benefit with specific eligibility criteria, the program includes checks to ensure that care continues to be medically appropriate. This isn’t about distrust of families or patients. It’s a system-wide safeguard built into how the benefit is designed.
  • It creates a natural moment for reassessment. Even outside of insurance requirements, regular reassessment is good clinical practice. Recertification visits give the hospice physician a reason to revisit symptom control, medication needs, equipment, and the goals of care, making sure everything still reflects what the patient and family want and need.
  • It supports continuity, not interruption. Perhaps most importantly for families: recertification, when completed properly, means hospice services continue without a gap. Medications keep arriving. Nursing visits continue. Equipment stays in place. The administrative process happens quietly so that the day-to-day care your loved one relies on doesn’t skip a beat.

What Families Can Expect During the Recertification Process

For most families, recertification happens largely behind the scenes. Your hospice team handles the documentation, scheduling, and physician sign-off as a normal part of ongoing care. Still, it helps to know what might show up on your radar:

  1. A scheduled visit from a hospice physician or nurse practitioner. Starting with the third benefit period, this face-to-face visit is required. The visit itself is usually calm and conversational; the clinician is checking in on comfort, symptoms, and overall condition, not conducting an exam that feels invasive or alarming.
  2. A conversation about how things have been going. Your hospice team may ask you and your loved one questions about recent changes, whether symptoms feel well-managed, and whether anything new has come up since the last review.
  3. Continuity of services. As long as the patient continues to meet eligibility criteria, recertification simply renews the benefit period. There’s no action required from families in most cases, no paperwork to sign, no gap in care to plan around.
  4. Possible adjustments to the care plan. Sometimes recertification visits surface small changes worth addressing, perhaps a new medication, an additional piece of equipment, or a referral to a service like physical therapy or specialized pain management. These adjustments are part of hospice doing its job well.

What If a Patient No Longer Meets Eligibility?

Occasionally, a patient’s condition improves enough that they no longer meet the criteria for hospice, often because their disease has stabilized longer than expected. When this happens, the hospice physician will not recertify the patient for the next benefit period.

This isn’t a punishment, and it isn’t a sign that something went wrong. If anything, it reflects a positive change in the patient’s condition. In these situations, the hospice team will talk openly with the family about what it means, what other services or care settings might be appropriate, and how to make the transition as smooth as possible. Patients can also be re-admitted to hospice later if their condition changes again and they once again meet the criteria.

What This Means for Your Family

At its core, recertification is one of the quiet mechanisms that keep hospice care running smoothly and responsibly. It exists to make sure that:

  • Care remains medically appropriate
  • Coverage continues without interruption
  • The care plan reflects the patient’s current condition
  • Families have a built-in checkpoint for questions and conversations with the care team

If your loved one is approaching a recertification period, you don’t need to prepare anything special. The best thing you can do is use it as a natural opportunity to ask your hospice team any questions you’ve been holding onto, about symptoms, about what to expect next, or about how the plan of care might evolve.

Related Reading

We’re Here for Your Loved One’s Care

Recertification is just one part of a much bigger picture: your loved one’s comfort, dignity, and quality of life. If you have questions about where things stand in their care plan, our team is happy to walk through it with you, plainly and at your pace.

Contact Journey Palliative and Hospice or call (818) 748-3427.

Setting Up a Safe Home for Advanced Dementia Hospice Care

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As advanced dementia progresses, the home environment plays a major role in a patient’s safety, comfort, and sense of calm. Simple changes: clearing walkways, securing wandering risks, adjusting lighting, and bringing in the right durable medical equipment can prevent falls, reduce confusion, and make caregiving easier. 

Hospice teams like Journey Palliative and Hospice can assess the home and help bring in equipment such as hospital beds, wheelchairs, and bathroom safety aids as part of hospice care.

Most of the changes that make a home safer for advanced dementia hospice care are practical and can be made gradually, often with support from your hospice care team, who can walk through the home with you and point out what to prioritize first.

Why Home Safety Looks Different With Advanced Dementia

In the advanced stages of dementia, patients often experience:

  • Increased confusion about time, place, and familiar spaces
  • Reduced mobility, balance, and coordination
  • Wandering or attempts to “go home” even while at home
  • Sensory changes that make shadows, reflections, or noise distressing
  • Difficulty recognizing hazards like stairs, hot surfaces, or sharp edges
  • Trouble communicating discomfort, pain, or needs

This means safety planning isn’t just about preventing falls – it’s about reducing confusion and agitation, too. A calm, predictable environment can ease anxiety for both the patient and the family caring for them.

It also means safety planning isn’t a one-time project. As the disease progresses, what worked a few months ago may no longer be enough. A bedroom setup that was fine when your loved one could still walk independently may need a hospital bed and lift six months later. Building in regular walkthroughs – ideally with input from your hospice nurse or aide – helps the home keep pace with changing needs instead of catching up after an incident.

Understanding the Most Common Risks

Before going room by room, it helps to understand the patterns behind most home safety incidents involving advanced dementia:

  • Falls. The leading cause of injury is often linked to disorientation (getting up at night and forgetting where the bathroom is), poor lighting, loose rugs, or attempting to walk without assistance when mobility has declined.
  • Wandering. Even patients who are largely bed-bound in late-stage dementia can have moments of restlessness or attempts to get up unassisted. Earlier in the disease, wandering out of the house is a serious safety concern.
  • Skin breakdown. Reduced mobility increases the risk of pressure sores, particularly for patients who spend most of their time in bed or a chair.
  • Dehydration and missed medications. Communication difficulties can mean a patient doesn’t express thirst, hunger, or discomfort in ways caregivers recognize.
  • Caregiver injury. Lifting, repositioning, and transferring a loved one without the right equipment is one of the most common causes of caregiver back and shoulder injuries.

Keeping these patterns in mind makes it easier to prioritize which changes matter most for your specific situation, rather than trying to do everything at once.

Room-by-Room Safety Checklist

Bedroom

The bedroom is where most patients in advanced hospice care spend the majority of their time, so it deserves the most attention.

  • Use a hospital bed with adjustable height and side rails to reduce fall risk and ease repositioning
  • Add a pressure-relief mattress to help prevent bedsores for patients with limited mobility
  • Keep a clear path to the bathroom, with night lighting along the route
  • Remove area rugs and excess furniture that create tripping hazards
  • Position the bed so caregivers can access both sides for repositioning and care tasks
  • Keep a phone, call bell, or baby monitor within reach so the patient (or caregiver) can signal for help

Bathroom

Bathrooms are one of the highest-risk rooms in the home due to hard, slick surfaces and the physical effort involved in transfers.

  • Install grab bars near the toilet and shower
  • Use a raised toilet seat or bedside commode if mobility is limited
  • Add non-slip mats inside and outside the shower or tub
  • Keep water temperature moderate to avoid burns, since temperature sensitivity often changes
  • Consider a shower chair for patients who can still bathe with assistance
  • Store razors, medications, and cleaning products out of reach or in locked cabinets

Living Areas

Shared spaces matter too, especially if your loved one still spends time outside the bedroom during the day.

  • Secure or remove loose cords, rugs, and clutter from walkways
  • Use furniture with rounded edges where possible
  • Keep frequently used items (glasses, remote, tissues) within easy reach to reduce frustration
  • Consider a wheelchair or walker for safe movement between rooms
  • Reduce visual clutter and strong patterns on floors or rugs, which can be disorienting for some dementia patients
  • Keep lighting consistent and avoid heavy shadows, which can sometimes be misread as objects or hazards

Kitchen and Doors

Even if your loved one no longer cooks, kitchens and exterior doors carry risks worth addressing early.

  • Install childproof locks on cabinets with cleaning supplies, medications, or sharp objects
  • Add door alarms or locks on exterior doors if wandering is a concern
  • Turn off or unplug small appliances when not in use
  • Consider a stove knob cover or shutoff if the patient still has access to the kitchen unsupervised

The Role of Durable Medical Equipment in Home Safety

Many of the safety adjustments above involve equipment that hospice care can provide and set up directly in the home. Through Journey’s durable medical equipment services, this can include:

  • Hospital beds and pressure-relief mattresses
  • Wheelchairs and walkers
  • Patient lifts for safer transfers
  • Oxygen equipment, CPAP, or BiPAP if needed
  • Feeding pumps for patients who require them

Equipment is inspected, delivered, and set up by the hospice team, and adjusted over time as the patient’s needs change. As an example, a patient who initially only needs a hospital bed and bedside commode may, weeks later, need a patient lift as mobility declines further. Your hospice team should be reassessing equipment needs at regular visits, not just at the start of care.

Creating a Calmer Sensory Environment

Beyond physical hazards, the sensory environment plays a meaningful role in comfort for someone with advanced dementia. A few adjustments families often find helpful:

  • Lighting: Soft, even lighting reduces shadows and glare. Nightlights in hallways and bathrooms help orient patients who wake during the night.
  • Noise: Background noise from TVs, multiple conversations, or appliances can be overstimulating. Familiar, quiet sounds (a favorite playlist, a fan) are often more soothing.
  • Familiar objects: Photos, blankets, or items with personal meaning placed within view can provide comfort and a sense of familiarity, even as memory changes.
  • Routine: Where possible, keeping mealtimes, care visits, and rest periods on a consistent schedule can reduce agitation.

These changes don’t require special equipment, just attention and small adjustments based on how your loved one responds.

Supporting the Caregiver, Too

Caring for someone with advanced dementia is physically and emotionally demanding. A safer home reduces the risk of caregiver injury (from lifting or assisting with transfers) and can lower stress for everyone in the household. Equipment like patient lifts and adjustable beds isn’t just for the patient’s safety – it protects the people doing the daily work of caregiving.

If you’re feeling overwhelmed, in-home caregiving and respite care services can provide additional hands-on support and short-term relief, giving family caregivers time to rest, run errands, or simply step away for a few hours.

When to Bring in Hospice Support

If your loved one’s dementia has progressed to the point where daily safety, mobility, or comfort has become difficult to manage at home, it may be time to talk with a hospice provider. Our What to Expect page walks through how the process typically begins, including an in-home assessment of needs, including safety and equipment.

A hospice team doesn’t just bring equipment. They also help families recognize which changes matter most for their specific situation, and provide ongoing support as needs shift over time.

A Calmer, Safer Home Starts With the Right Support

You don’t have to figure out every adjustment on your own. Journey Palliative and Hospice can assess your loved one’s home, recommend changes, and bring in the equipment needed to make daily life safer and more comfortable.

Call (818) 748-3427 or request care now to schedule a home assessment with our team.

Hospice Care at Home vs. Facility: Choosing the Right Setting for Your Loved One

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When a loved one qualifies for hospice, one of the first practical decisions families face is where that care will happen. Hospice can be provided in the home, in a nursing facility, in an assisted living community, or in a dedicated inpatient hospice setting. Each option looks different in practice, and neither is universally better. 

The right setting depends on your loved one’s medical needs, your family’s caregiving capacity, and the environment where your loved one feels most at ease. This guide walks you through what each option involves so you can make a clear, informed decision.

Where Hospice Care Can Be Provided

A common misconception is that hospice requires moving to a specific facility. In reality, according to the Centers for Medicare and Medicaid Services (CMS), hospice care is a benefit that follows the patient, not a building. Under the Medicare Hospice Benefit, care can be delivered in:

  • The patient’s private residence
  • A family member’s home
  • An assisted living facility or board and care home
  • A skilled nursing facility (SNF)
  • A dedicated inpatient hospice facility

The hospice care team, which includes nurses, social workers, chaplains, aides, and physicians, comes to wherever your loved one is living. Understanding what each setting looks and feels like is the starting point for making this decision well.

In-Home Hospice Care: What to Expect

For many families, keeping a loved one at home is the most meaningful option. It preserves routine, surroundings, and closeness. In-home hospice allows your loved one to remain in a familiar environment, surrounded by family, their own belongings, and the comfort of home.

Under this model, the hospice team visits on a scheduled basis. Nurses conduct regular assessments, manage medications, and respond to changes in condition. Aides assist with personal care and hygiene. Social workers address emotional and practical needs. Chaplains are available for spiritual support. Equipment is delivered directly to the home under the Medicare Hospice Benefit. Learn more: durable medical equipment.

In-home hospice works well when:

  • A family member or caregiver is available at home consistently
  • The patient’s symptoms are stable and manageable in a home setting
  • The patient has expressed a preference to remain at home
  • The home environment can safely accommodate care needs (space, accessibility, proximity to support)

What families should prepare for:

In-home hospice does not mean around-the-clock nursing care. Visits are scheduled, and families carry a significant caregiving role between those visits. This can be deeply meaningful, but it is also demanding. If caregivers are experiencing burnout or need temporary relief, respite care provides short-term relief so family caregivers can rest without disrupting their loved one’s care.

Facility-Based Hospice Care: What to Expect

When the home setting is no longer practical, or when a patient’s symptom burden requires a higher level of clinical oversight, facility-based hospice becomes the more appropriate path. This includes care provided in nursing facilities, assisted living communities, or dedicated inpatient hospice units.

  • Skilled Nursing Facilities (SNFs) and Assisted Living. If your loved one is already residing in a skilled nursing facility or an assisted living community, hospice care can be layered on top of that existing placement. The hospice team coordinates with facility staff to manage comfort-focused care while the facility continues to provide room, board, and custodial support. 
  • Inpatient Hospice Facilities. When symptoms such as severe pain, uncontrolled nausea, respiratory distress, or acute agitation cannot be managed safely at home, Medicare provides coverage for General Inpatient (GIP) care. This is a short-term, crisis-level level of care provided in a dedicated inpatient hospice unit or a contracted hospital. GIP care is intended to stabilize symptoms, not as a permanent placement. Once symptoms are controlled, the patient typically transitions back to their home or facility setting.
  • Facility-based care works well when:
    • Symptom management requires 24-hour clinical monitoring
    • Family caregivers are not physically or emotionally able to manage care at home
    • The patient already lives in a nursing home or assisted living community
    • Safety concerns at home, such as fall risk, complex wound care needs, or equipment requirements, make home care difficult. Our wound care and specialized pain management services are available across care settings. 

Comparing the Two Settings Side by Side

FactorIn-Home HospiceFacility-Based Hospice
Familiar environmentYes, the patient stays at homeLimited, though personal items can help
Family involvementHigh, family central to daily careSupported, but less hands-on
24-hour nursing accessAvailable by phone; visits scheduledOn-site staff around the clock
Best forStable symptoms, available caregiversComplex symptoms, limited home support
Caregiver burdenHigherLower
Patient preferenceOften preferred by patientsMay be preferred for safety or comfort
Medicare coverageCovered under hospice benefitCovered under hospice benefit (GIP for acute needs)

Questions to Help Your Family Decide

There is no single right answer. These questions can help your family work through the decision together:

About your loved one:

  • Where does your loved one feel most at peace?
  • What is the current level of symptom complexity? Are pain, breathing, or agitation difficult to manage?
  • Does your loved one have mobility limitations, fall risk, or wound care needs that require frequent clinical attention?

About your family’s capacity:

  • Is there a family member who can be present at home consistently?
  • Has caregiving already been taking a physical or emotional toll? Read our related post on Bereavement Counseling vs. Therapy: Which One Do You Need? for support resources if caregiver grief is already present.
  • Does your home environment accommodate the equipment and safety needs of your loved one?

About the care itself:

  • Are your loved one’s symptoms currently stable, or are they changing rapidly?
  • Has your hospice team expressed any clinical concerns about managing care at home?

If you are uncertain how to weigh your answers, the team at Journey Palliative and Hospice can walk through this with you. Our care coordinators help families assess the right setting based on medical need, family circumstances, and personal wishes. Visit our What to Expect page to understand how the conversation with our team typically unfolds.

What Journey Palliative and Hospice Provides Across Settings

At Journey Palliative and Hospice, we provide care across home and facility settings throughout Burbank and Los Angeles County. Our interdisciplinary team includes registered nurses, home health aides, social workers, chaplains, and physicians who coordinate together to ensure consistent, compassionate care regardless of where your loved one is receiving it.

Our services include:

Frequently Asked Questions

  • Can hospice be provided in an assisted living facility? Yes. The Medicare Hospice Benefit can be used in an assisted living community.
  • Does choosing in-home hospice mean a family member must be present 24 hours a day? Not as a formal requirement, but practically, someone should be available and reachable. Hospice nurses are on call around the clock and can visit or advise by phone, but they do not provide continuous in-home nursing unless the patient is on Continuous Home Care, a specific level of care for short-term symptom crises.
  • What if the patient’s condition worsens at home? Your hospice nurse will reassess the situation and may recommend a temporary transition to General Inpatient (GIP) care to stabilize symptoms. Once stable, the patient can return home if that remains the preferred setting.
  • Is facility-based hospice more expensive for the family? Under Medicare, the hospice benefit covers the hospice team’s services regardless of setting. In a skilled nursing facility or assisted living community, the facility’s room and board costs are generally separate.

Ready to Talk Through Your Options?

Choosing a care setting is one of the most personal decisions a family can make. There is no wrong answer when it comes from a place of love, honest reflection on your loved one’s needs, and a realistic look at what your family can provide.

The Journey Palliative and Hospice team is here to help you think through every part of this decision without pressure and without rush.

Call us at (818) 748-3427 or contact us online to speak with a care coordinator today. We serve families in Burbank and throughout Los Angeles County.

What Happens If You Decide to Leave Hospice Care?

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Leaving hospice care is a choice that belongs entirely to you and your family. Under Medicare and most insurance plans, any patient enrolled in hospice has the right to revoke their hospice benefit at any time for any reason. 

When you leave, your regular Medicare or insurance benefits are restored, and you can return to curative treatment or other care options. If your situation changes again later, you can re-enroll in hospice. There are no penalties, no waiting periods, and no judgment.

You Always Have the Right to Leave

One of the most misunderstood things about hospice is that it feels permanent when it is not. Many families hesitate to enroll because they fear it is a one-way door. It is not.

According to the Centers for Medicare and Medicaid Services (CMS), patients enrolled in the Medicare Hospice Benefit can revoke their election at any time and for any reason. The same protections apply under most private insurance and Medicaid hospice programs.

This is an important protection to understand. Enrolling in hospice care does not lock you in. It gives you and your loved one access to specialized comfort-focused support while leaving the door open for different decisions later.

What Triggers a Decision to Leave Hospice?

There is no single reason why families consider leaving hospice. Some common situations include:

  • A patient’s condition stabilizes or improves beyond what was expected
  • A family decides to pursue curative or disease-modifying treatment again
  • A new treatment option becomes available that the patient or family wants to try
  • A patient or family member simply wants a different care approach

All of these are valid. If you are unsure whether a change in your loved one’s condition means hospice is still the right fit, reach out to your hospice care team. A conversation with your nurse or physician is always the right first step. If you are still weighing your options, our blog on Hospice vs. Continuing Treatment: How Families Decide walks through how other families have thought through this decision.

What Formally Revoking Hospice Looks Like

Revoking hospice is a formal process, but it is straightforward. Here is what typically happens:

  • Step 1: Submit a written revocation statement. You will sign a written statement confirming your decision to end hospice care. This document is called the Notice of Election Revocation. The hospice provider prepares it, and it is effective on the date you sign it or a future date you specify.
  • Step 2: Your hospice services stop. Once the revocation takes effect, the hospice team will no longer provide services under the hospice benefit. This includes visits from nurses, aides, social workers, chaplains, and any hospice-covered medications or durable medical equipment.
  • Step 3: Your standard Medicare or insurance benefits are restored. Your regular Medicare Part A and Part B coverage resumes immediately. This means you can see your primary physician, return to specialists, and pursue treatments that were paused during hospice enrollment.

There are no financial penalties for revoking. Any days you used in your current benefit period are counted, but your access to Medicare and insurance coverage returns right away.

What Happens to Your Medications and Equipment?

This is one of the most practical questions families ask when considering a revocation. While enrolled in hospice, many medications, supplies, and equipment are covered because they relate to your terminal diagnosis. Once you revoke, those items are no longer covered under the hospice benefit.

Before your revocation takes effect, it is worth speaking with your care team about:

  • Which medications will need to transition to your standard Medicare Part D coverage
  • Any equipment currently in the home that belongs to the hospice provider
  • How quickly transitions will happen so there is no gap in comfort or safety

Your hospice nurse and social worker can help coordinate this transition carefully. At Journey Palliative and Hospice, our team walks families through every practical detail so that nothing falls through the cracks during a care transition.

Can You Come Back to Hospice After Leaving?

Yes. You can re-enroll in hospice after revoking.

Under Medicare, a patient can re-elect the hospice benefit any number of times. Each benefit period has a set structure (two 90-day periods followed by unlimited 60-day periods), but leaving and returning does not disqualify you. If your condition declines again after returning to curative treatment, or if you simply decide that comfort-focused care is the right path again, re-enrollment is available.

Re-enrollment requires a new certification from your physician and hospice medical director confirming that your prognosis is six months or less if the illness runs its normal course, as defined by Medicare criteria.

Support Does Not Have to Stop When Hospice Does

One thing families sometimes do not expect is how much they grieve the loss of their hospice support team when care ends. Your hospice nurses, aides, and social workers often become trusted faces during an incredibly vulnerable time.

If you or your family are navigating difficult emotions during or after this transition, bereavement services remain available. Our bereavement counselors at Journey Palliative and Hospice support families through anticipatory grief and loss regardless of how or when care ended. For more on the difference between grief support options, see our blog on Bereavement Counseling vs. Therapy: Which One Do You Need?

Frequently Asked Questions

  • Can a patient be discharged from hospice without choosing to leave? Yes. A hospice provider can discharge a patient if the patient’s condition improves to the point that they no longer meet eligibility criteria, or if they move outside the provider’s service area. This is called a live discharge and is separate from a voluntary revocation. 
  • Does leaving hospice affect future Medicare coverage? No. Revoking your hospice election does not reduce or eliminate your overall Medicare benefits. Standard Part A and Part B coverage resumes as of the revocation date.
  • What if my loved one cannot make the decision themselves? If the patient cannot make decisions independently, the legal health care decision-maker, often a family member or designated healthcare agent, can submit the revocation on their behalf.
  • How much notice do I need to give? There is no required advance notice period. You can revoke it on the same day you decide. The revocation date can be the date of signature or a future date of your choosing.

You Are Not Alone in This Decision

Deciding to leave hospice, or even considering it, is not a sign that you made the wrong choice by enrolling. Life changes. Conditions change. Family circumstances change. The right kind of care at any given moment is the one that best supports your loved one’s comfort, dignity, and goals.

If you have questions about revoking your hospice election, transitioning to a different level of care, or simply want to talk through your options, the Journey Palliative and Hospice team is here to help. We serve families in Burbank and throughout Los Angeles County.

Call us at (818) 748-3427 or contact us online to speak with a care coordinator. There is no pressure and no obligation. Just a conversation.

See What Our Clients Are Saying About Us!

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Serine K.
2 months ago
Our family is deeply grateful for the exceptional care and compassion provided by Journey Palliative hospice team during my father-in-law’s final days. From the very beginning, they were always there for us 24/7 responding quickly to every request and ensuring that all of his needs were met with professionalism and kindness. A special thank you to Ovsanna, RN whose knowledge, expertise, and dedication to patient care were truly remarkable. She handled every situation with confidence, compassion, and professionalism, providing guidance and reassurance to our family during an incredibly difficult time. The continuous care provided by the experienced and professional nursing staff was an enormous source of comfort and support. Knowing that skilled and caring nurses were by his side gave us peace of mind and allowed us to focus on spending precious time with our loved one. Throughout this journey, the entire hospice team showed genuine understanding, empathy, and respect. They treated our father-in-law with dignity and cared for our family as if we were their own. Their support made an immeasurable difference during one of the most challenging times of our lives. We cannot thank them enough for their outstanding service, compassion, and unwavering commitment to providing exceptional end-of-life care. We highly recommend Journey Palliative and Hospice services to any family in need of professional, caring, and trustworthy support and will definitely consider working with them in the future if any of our family member may need hospice services and care.
Zahira I.
6 months ago
We are incredibly grateful for the hospice team and the care they provided during such a difficult time. Everyone was kind, informative, and truly supportive every step of the way. They truly made the process feel less overwhelming. We also deeply appreciate the delivery drivers who would come late at night to make sure we had the medications we needed, their dedication truly meant so much to us. We couldn’t have asked for better care and are so thankful for everything they did for us.
Adrine K.
7 months ago
We are deeply grateful for the compassionate care and support this hospice team provided to my late father. During an incredibly difficult time for our family, they treated him with dignity, kindness, and genuine respect. Nurse Ovsanna, in particular, made an extraordinary difference through her gentle presence, unwavering compassion, and genuine dedication. She cared for my father as if he were her own, offering comfort, reassurance, and heartfelt kindness when we needed it most. The staff was attentive, patient, and always available to answer questions or offer comfort—not only to my father, but to our entire family. Their guidance helped ease our worries and allowed us to focus on spending meaningful time together. We will never forget the warmth, professionalism, and empathy they showed, and we truly appreciate everything they did for our father in his final days.
Martiros S.
7 months ago
Journey Palliative and Hospice came into our lives during one of the hardest seasons we have ever faced, and they truly felt like a blessing. From the moment they began caring for my mother, it was clear that she was in loving, compassionate hands. She was in their care for quite some time, and throughout that journey, the entire hospice team showed extraordinary kindness—not only to my mother, but to our whole family. My mother was treated with unwavering dignity, respect, and genuine love. Every interaction reflected how deeply they cared for her comfort, her peace, and her humanity. They tended to her physical needs with professionalism and urgency, while also surrounding our family with emotional support, patience, and understanding. They listened to us, reassured us, and walked beside us through every painful step. During a time filled with uncertainty and heartache, their compassion and empathy brought us comfort and strength. The difference they made in our lives is immeasurable, and we will always be grateful for the care they gave my mother and the kindness they showed our family. We wholeheartedly recommend Journey Palliative and Hospice to any family seeking truly compassionate, patient-centered end-of-life care.
Sharon
8 months ago
I really cannot imagine how I would have gotten through the last chapter of my mother's live as her 24/7 caretaker without the kind wisdom, and steadying...
Sharon
8 months ago
I really cannot imagine how I would have gotten through the last chapter of my mother's live as her 24/7 caretaker without the kind wisdom, and steadying...
Rosio A.
10 months ago
I am so very grateful to Journey Palliative and Hospice care for the amazing care they gave my sister. They came to our home and provided everything she...
Rosio A.
10 months ago
I am so very grateful to Journey Palliative and Hospice care for the amazing care they gave my sister. They came to our home and provided everything she...
chris M.
2 years ago
I had an amazing tour and discussion about the features and services at Journey Palliative Hospice. I found thier staff to be very attentive and caring to the patients while I was there
Pam R.
2 years ago
My Mom was under their care for a month. They are the most kind caring people. They knew just what to do at all stages. It was a very difficult time but they help me get through it every moment. Thank you so much .