Continuity of Care

Hospice care is available 24 hours a day, 7 days a week, and services continue without interruption if the patient care setting changes.
If a patient transfers from one hospice program to another or from home care service to inpatient service (or vice versa), the service transferring care provides a written summary which includes information about:
• Services being provided
• Specific medical, psychosocial, spiritual, or other problems that require intervention or follow-up
• Planned follow-up by an interdisciplinary team member from the service transferring care.

A hospice patient should be discharged only in the following very specific circumstances:
• Patient moves from the service area
• Change in terminal status
• Patient and family is unwilling to comply with the hospice plan of care and consistently acts in a way which compromises the hospice standards of care
• Issues of patient safety cannot be resolved
• Issues of staff safety cannot be resolved
• Patient and family desire discharge