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Jose Escobar · Jun 01, 2025 · 5 min read

How Do I know It's Time for Hospice?

“How Do I Know It’s Time for Hospice?” – A Nurse’s Conversation with Families
This is one of the most difficult questions you’ll ever face—and one of the most important.
Families rarely wake up one day and decide it’s time for comfort care. Most of the time, they’ve been fighting. Doing everything possible. Choosing every treatment. Hoping for another option.
But sometimes… more treatment doesn’t bring more time. It just brings more suffering.
This isn’t about giving up.
This is about recognizing when the care being given is no longer helping—and may even be hurting.
Doctors call this the futility of care. We see it when treatments continue, but outcomes don’t improve. When hospital visits stack up, but healing doesn’t follow. When the side effects start outweighing the benefits.
That’s when the question shifts from: “What else can we try?” to “What actually brings comfort? What matters most now?”
That’s where hospice comes in.
Not as an ending. But as a change in focus—from extending life at all costs, to improving the life that’s left.
And there’s a real process for knowing when that time may have come. It's not guesswork. It’s based on clinical patterns, medical guidelines, and what we see every day at the bedside.
Let me walk you through it—gently, clearly, and with no pressure.

1. Changes in Health Over Time (Disease Trajectory)

Start by asking yourself: “How has their health changed over the last year? Six months? The last few weeks?”
We’re looking for patterns like:
  • More trips to the hospital or emergency room
  • More infections, like pneumonia or UTIs
  • More falls or sudden changes in alertness
  • Needing more help to do everyday things
  • A shift from being able to walk and talk—to needing help with everything
When you see these kinds of declines happening over time, that’s often the first sign that things are progressing.

2. Changes in Eating and Weight (Nutrition)

Next, ask: “Are they eating less than before? Are they losing weight? Have we started using nutritional shakes or supplements?”
Why does this matter?
Because when someone is getting weaker or their body is shutting down, it often shows up in their appetite and weight:
  • Unplanned weight loss
  • Clothes fitting more loosely
  • Needing Ensure, Boost, or other nutrition drinks just to keep going
  • Starting to look thinner or frailer
For people with dementia, cancer, ALS, liver, or kidney disease, these signs are especially important.

3. Changes in What They Can Do (Function)

Now think about what they can do by themselves—and what they can’t anymore:
  • Can they get dressed without help?
  • Can they walk, go to the bathroom, or eat on their own?
  • Are they spending most of their time in bed or a chair?
If they’ve become fully dependent—or almost fully dependent—this tells us their body is slowing down.
Families often feel the impact here the most. It’s hard seeing someone who used to be independent now needing help with everything.
4. Changes Specific to Their Diagnosis
Every illness has its own signs that someone may be entering the last stage.
Let me share a few examples:
Heart or Lung Disease (like CHF or COPD):
  • Shortness of breath even when resting
  • Needing oxygen most of the time
  • Swelling in the legs (edema), sometimes in the arms, and occasional bloating or fullness in the belly from fluid buildup
  • Multiple hospital visits in recent months
Dementia, Parkinson’s, ALS, or Stroke:
  • Can’t talk clearly or at all
  • Trouble swallowing, choking on food or liquids
  • Repeated lung infections
  • Barely eating or losing weight fast
Cancer:
  • Stopping chemo or radiation
  • Cancer has spread to other parts of the body
  • Weaker despite treatment
  • Choosing comfort instead of another round of aggressive treatment
Kidney or Liver Failure:
  • Skipping dialysis or deciding to stop it
  • Swelling, confusion, or fluid in the belly
  • No plans for a transplant

These diagnosis-specific signs help doctors determine if hospice is appropriate, but as a loved one, you are often the first to notice them.

So, What’s the General Rule?

If your loved one is:
  • Getting weaker over time
  • Eating and drinking less
  • Needing more help to do basic things
  • …and showing signs related to their illness?
Then it may be time to ask for a hospice evaluation.
Remember: hospice doesn’t rush anything. We don’t take over. We don’t take away hope.
We add comfort. We add clarity. We add time spent together without unnecessary suffering.
Only a hospice physician can make the final decision—but you don’t have to wait until things get worse to ask.

One More Thing: You're Not Alone

Choosing hospice is never about giving up. It’s about stepping into a different kind of care—a care that puts your loved one at the center and gives your family support every step of the way.
So if you’re wondering if it’s time… it might be time to just talk.
We’ll walk with you.

To find a hospice near you: https://www.nationalhospicelocator.com/

Jose Louis Escobar is Founder/CEO of Polaris Support Global
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