Free Hospice Discharge Checklist Download

Hospice discharge is a pivotal moment in the care journey. Whether due to revocation, ineligibility, or patient choice, a well-prepared discharge minimizes disruption, supports continuity, and helps families understand what to expect next. Without clear communication and structured planning, patients may face gaps in care, unnecessary hospitalizations, or confusion around next steps.

A hospice discharge checklist provides a standardized process to address medical, legal, emotional, and logistical considerations before the patient leaves hospice services. This article outlines the core components of an effective checklist, why it matters, and how to apply it in daily operations.

This discharge checklist will help facilitate a safe, smooth, and seamless transition from hospital/hospice care for the dying person who chooses to be cared for at home.

• Hospital/hospice staff must prioritize the discharge as URGENT to minimize any potential delays.

• Involve the person and their family and/or caregiver in the discharge details and the plan of care.

• Contact the person’s general practitioner (GP) and ensure the GP is supportive of the discharge. Advise the person and their family of the importance of a GP visit soon after discharge if death is imminent.

• Refer to the relevant community nursing service(s) in good time and consider arranging for referral to specialist palliative care/hospice.

• Where appropriate, ensure sufficient subcutaneous medications are prescribed and available in the home, with the relevant authorities.

Why Hospice Discharge Requires Careful Coordination

Hospice discharges are relatively uncommon but must follow Medicare regulations. The Centers for Medicare & Medicaid Services (CMS) recognizes several legitimate reasons a patient may be discharged from hospice care, including:¹ 

• The patient is no longer terminally ill, meaning their prognosis has improved beyond the six-month eligibility threshold.

• The patient or their representative revokes the hospice benefit, often to pursue curative treatment or alternative care.

• The patient moves out of the hospice’s service area, making continued services impractical or non-compliant.

• The hospice initiates a discharge for cause, such as when safety concerns arise and cannot be resolved despite documented interventions.

Regardless of the reason, discharges require written documentation, communication with caregivers, and coordination of follow-up care.

Without a structured approach, important steps like medication reconciliation or DME pickup can be missed, leading to confusion and potential gaps in care.

Key Components of a Hospice Discharge Checklist

A standardized checklist improves internal consistency and quality by giving teams a reliable process. Below are core components often included:

1. Eligibility Review and Documentation

Before any discharge, the interdisciplinary team (IDT) must review documentation to support the reason. This includes:

• Physician narrative explaining the prognosis change

• Updated clinical assessments and recertification data

• Signed revocation form (if applicable)

• Discharge order by the hospice physician

For patients in their third or later benefit periods, CMS also requires a face-to-face (FTF) encounter with a hospice physician or nurse practitioner prior to recertification. This visit must clearly support a life expectancy of six months or less and be documented in the medical record.²

Documentation must be clear, dated, and stored in the medical record per CMS guidelines. Thorough, well-organized records not only support safe transitions but also protect the organization in the event of audits, surveys, or billing reviews.

2. Caregiver and Patient Education

Discharge can be distressing, especially when it isn’t initiated by the patient or family. Education should cover:

• Reason for discharge

• What will and won’t change (e.g., medications, services)

• Options for follow-up care (home health, primary care, oncology)

• Emotional and spiritual support referrals

Checklists can prompt clinicians to schedule a discharge conference with the patient and caregiver to address these topics directly. It’s important to confirm that the patient or representative understands the discharge reason and next steps, and to document this discussion in the medical record.

3. Medication and Equipment Coordination

Before discharge:

• Conduct a full medication review.

• Clearly indicate which medications should be continued, adjusted, or stopped.

• Coordinate with a pharmacy or prescriber to refill ongoing prescriptions.

• Arrange for the return or pickup of durable medical equipment (DME).

This reduces the risk of medication errors and avoids equipment billing complications. It also helps ensure the patient has uninterrupted access to essential medications and supplies during the transition, supporting symptom management and reducing the likelihood of unnecessary ER visits or care delays.

4. Post-Discharge Plan of Care

To maintain continuity, hospices should provide a transition plan that includes:

• Contact information for future providers

• Copies of recent clinical notes

• Recommendations for follow up (e.g., pain management, wound care)

• Emergency instructions

Although hospices are not required to coordinate care after discharge, doing so supports safer transitions and may reduce preventable emergency visits or rehospitalizations. When possible, a warm handoff (such as a direct call to the receiving provider) can strengthen continuity and demonstrate patient-centered care. This plan should be shared with the patient and family in writing and documented in the record.

Example: Applying the Hospice Discharge Checklist in Practice

Hospice discharges can take many forms—whether prompted by changes in prognosis, patient choice, or other factors. The following examples illustrate how a structured checklist helps teams navigate different types of discharge with clarity, compliance, and compassion.

Case 1

A 76-year-old patient with end-stage chronic obstructive pulmonary disease shows functional improvement and no longer meets hospice eligibility criteria after 180 days. Here’s how the hospice discharge checklist helped guide a smooth and coordinated transition:

1. Documentation:

The attending hospice physician provides a written explanation and signs the discharge order. The IDT meets to confirm the prognosis change, and the eligibility review is documented in the patient’s chart.

In cases of revocation, it’s important to note that the request must come directly from the patient or their legal representative through a signed written statement. Verbal revocations are not permitted, and hospices may not suggest or request that a patient revoke their benefit.²

2. Family Meeting:

The RN and social worker meet with the patient and daughter. They explain the reason for discharge and provide written materials outlining the next steps.

3. Medication Review:

The hospice pharmacist reconciles medications. Non-hospice prescriptions are sent to the patient’s PCP. DME pick up is arranged within 48 hours.

4. Care Transition:

The hospice team provides a printed care summary and facilitates a referral to a local pulmonologist and home health agency. The family is given after hours contact numbers for support during the transition.

Using a checklist in this case helped the team coordinate care and reduced the family’s anxiety about what happens next.

Case 2

A 68-year-old patient with advanced pancreatic cancer decides to pursue a new experimental treatment and revokes the hospice benefit to resume curative care. Here’s how the hospice discharge checklist can guide the care team through a compliant and compassionate transition in this scenario:

1. Documentation:

The patient expresses interest in resuming aggressive treatment after learning about a clinical trial. The hospice RN discusses the process and confirms the decision. The patient’s legal representative submits a signed revocation statement, dated the same day. The attending physician documents the conversation and reviews the plan with the IDT.

2. Family Meeting:

A discharge conference is held with the patient and spouse to clarify what services will end, outline next steps, and offer emotional and spiritual support. The chaplain provides additional counseling during the transition.

3. Medication and Equipment:

The hospice team reconciles medications and coordinates with the patient’s oncology team for a new prescription plan. DME pickup is scheduled, and instructions are given for discontinuing hospice-covered supplies.

4. Post-Discharge Plan:

The hospice provides a written summary of recent care and symptoms, along with contact information for the patient’s oncology team and primary care provider. The team also includes emergency contact guidance for symptom flares during the transition.

Using the checklist ensured the team followed CMS regulations while supporting the patient’s autonomy and helping the family understand the shift in care. Coordination between hospice and the new care team helped avoid delays in restarting treatment.

Compliance Considerations

Hospices must comply with Medicare regulations when discharging a patient. Failing to follow correct procedures may trigger audit risks or payment recoupments. According to CMS:²

• Discharge orders must be signed by the hospice physician.

• Revocations must be patient-initiated, in writing, and dated.

• Hospices must document that the patient is informed of their rights, including the reason for discharge and what to expect next.

• The interdisciplinary team (IDT) must be involved in reviewing and supporting the discharge decision, with documentation reflecting clinical justification. 

• The day of discharge or revocation is considered billable, and hospices must submit appropriate termination or revocation notices to Medicare.

A well-maintained checklist supports compliance and offers documentation during audits or surveys.

Tips for Creating or Updating a Hospice Discharge Checklist

Whether developing a new tool or refining an existing one, consider the following:

• Make it role-specific: Break down responsibilities by discipline—RN, social worker, chaplain, medical director.

• Use clear language: Avoid jargon and make it easy to follow.

• Build in prompts for communication: Include reminders to call caregivers, providers, and vendors.

• Include a verification section: Add a place for signatures or timestamps to confirm each item was completed.

• Review the checklist periodically: Collaborate with your quality team to update based on regulation changes or feedback from staff.

• Center the patient and family experience: Add prompts that help assess understanding, emotional readiness, and access to follow-up instructions in their preferred format.
  

Review the checklist periodically with your quality team to update based on regulation changes or feedback from staff.

Supporting Quality at the Point of Discharge

Hospice discharges involve multiple steps and carry emotional and logistical weight. A well-structured hospice discharge checklist supports clear communication, prevents oversights, and promotes smoother care transitions. While each discharge situation may differ, a consistent approach grounded in best practices and compliance standards can help hospice teams deliver quality care even at the point of discharge.

Medbridge’s hospice software is built to streamline workflows, support compliance, and improve coordination at every stage of care, including discharge. From customizable templates to integrated communication tools, our solution helps teams focus more on patients and less on paperwork.

References

1. CGS Medicare Jurisdiction 15. (2021, April 19). Hospice discharge, revocation and transfers. CGS Medicare. https://www.cgsmedicare.com/hhh/coverage/coverage_guidelines/discharge_revocations_transfers.html#a001

2. Centers for Medicare & Medicaid Services. (2025). Medicare Benefit Policy Manual (Pub. 100‑02), Chapter 9: Coverage of Hospice Services. § 20.2 Election, Revocation, and Change of Hospice. Retrieved from https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c09.pdf