What to Expect in the First Week of Hospice: A Family Guide to the Transition
By CRYSTAL BAI •
The short answer: In the first week of hospice, a team of nurses, social workers, chaplains, and aides will assess your loved one and begin delivering comfort-focused care. Expect an initial evaluation visit, medication changes to manage symptoms, equipment delivery, and emotional support for the whole family. The transition can feel overwhelming — a death doula can help you navigate every step.
Day 1-2: The Hospice Admission Assessment
Within 24-48 hours of hospice enrollment, a registered nurse will visit the home (or facility) to conduct a comprehensive assessment of your loved one's condition. They will review current medications, eliminate those that no longer serve comfort goals, and add or adjust medications for pain, breathlessness, anxiety, and other symptoms. They will also deliver a comfort kit — also called an emergency kit or hospice kit — containing medications for common end-of-life symptoms. Your death doula can be present for this visit to help you ask questions and understand what's being said.
Equipment Delivery and Home Preparation
Hospice supplies a hospital bed, wheelchair, bedside commode, oxygen if needed, and other durable medical equipment — usually delivered within 24-72 hours. A death doula can help you rearrange the living space to accommodate equipment, maintain a sense of warmth and personalization in what becomes a medical environment, and brief family members on how to use new equipment safely.
Meeting Your Hospice Team
In the first week, you will meet the core hospice team: your primary nurse (usually visits 2-3x/week), a social worker (weekly), a chaplain (offered, not required), a hospice aide (daily hygiene assistance), and a volunteer coordinator. A death doula is not part of the hospice team — they are a separate, complementary support — but can coordinate with the hospice team to avoid duplication and fill gaps, particularly during overnight hours or periods of high family need.
Medication and Symptom Management Changes
Expect significant medication changes in the first week. Curative medications — statins, blood pressure medications, dialysis — are typically stopped. Comfort medications — opioids for pain and breathlessness, benzodiazepines for anxiety, anticholinergics for secretions — are started or optimized. Families are taught to administer the comfort kit medications in urgent situations. A death doula helps families feel confident with these medications and reduces fear around administering them.
Emotional and Family Support in the First Week
The first week of hospice is often the most emotionally intense. The reality of the prognosis becomes concrete. Family members may disagree about care decisions. Children need age-appropriate explanations. A death doula provides consistent emotional support throughout — sitting with the patient, holding space for family grief, and facilitating family conversations that the hospice team doesn't have time to facilitate.
What to Ask Your Hospice Team in Week One
Key questions: What medications are in the comfort kit and when do I use them? Who do I call at 2am if there's a crisis? What are signs that death is approaching? What do I do when my loved one dies at home? A death doula can help you prepare these questions and understand the answers.
Frequently Asked Questions
How often will hospice nurses visit in the first week?
Most hospice patients receive nursing visits 2-3 times per week, with phone availability 24/7. In the first week, visits may be more frequent as the team establishes care.
What is a hospice comfort kit?
A comfort kit (also called an emergency kit or 'go box') is a set of medications provided by hospice for common end-of-life symptoms — typically liquid morphine, lorazepam (for anxiety), haloperidol (for agitation), and glycopyrrolate (for secretions). You administer them under nurse guidance.
Does hospice cover a death doula?
No — hospice is a Medicare-covered benefit for medical care. A death doula is a separate, out-of-pocket service. However, many families find that a death doula fills critical gaps in overnight support, family communication, and emotional guidance.
Can a death doula be present during hospice?
Yes — death doulas and hospice teams work together regularly. A doula complements, not replaces, hospice care by providing additional presence, family support, and practical guidance.
What happens if my loved one improves on hospice?
If a patient's condition stabilizes or improves, hospice can be paused and resumed. The six-month prognosis for hospice eligibility does not mean the patient must die within six months.
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