When care turns to comfort
Hospice, POLST, palliative care, and end-of-life planning in Washington, in plain terms. What each one is, what it covers, and how to keep your person comfortable and in control.
8 minute read. Última revisión 2026-06-30.
There is a point where the goal of care shifts. It stops being about fixing the illness and starts being about comfort, dignity, and time that feels like your person's own. That shift is not giving up. It is a different kind of care, and its whole focus is keeping your person comfortable. This guide walks through the pieces that matter in Washington. A POLST form so first responders honor your person's wishes. The Medicare hospice benefit and what it really covers. Palliative care as an earlier option. The state's Death with Dignity law, stated plainly. And grief support for the family, including the part that comes after. Take it slowly. You do not have to sort all of this out today.
Ideas equivocadas comunes
The things families most often get wrong about hospice and end-of-life care.
Idea equivocadaHospice means giving up, and it is only for the last few days.
La realidadHospice is a full benefit for anyone with a prognosis of six months or less if the illness runs its normal course. Many people use it for months, not days, and families often say afterward that they wish they had started sooner. It is comfort-focused care, not the end of care.
Idea equivocadaOnce you choose hospice, you can never go back to regular treatment.
La realidadChoosing hospice is not a one-way door. A person can leave hospice and resume curative treatment at any time, then return to hospice later if they choose. Outliving the six-month prognosis does not end coverage either. The benefit renews with recertification.
Idea equivocadaWe have an advance directive in a drawer, so paramedics will know what to do.
La realidadAn advance directive is important, but it is not an order that EMS can act on at the bedside. Paramedics and first responders follow a signed POLST form or a DOH DNR order. Without one of those, the default is to attempt full resuscitation, whatever the directive in the drawer says.
Idea equivocadaA POLST form replaces the advance directive.
La realidadThey do different jobs and you want both. An advance directive names a health-care agent and states general wishes. A POLST is a medical order for a specific seriously-ill person that EMS must follow. POLST does not name an agent, and it does not replace the directive. They work together.
Idea equivocadaHospice will pay for my person's room in assisted living or the nursing home.
La realidadHospice covers the care, not the rent. The Medicare hospice benefit does not pay the room-and-board cost of living in an adult family home, assisted living, or a nursing home. Those living costs are still owed separately. This surprises many families, so plan for it.
Qué hacer
You do not have to do these all at once. Take them in the order that fits where your person is right now.
- Paso 1Put a POLST and an advance directive in place, and know what each does
For a seriously ill or frail person, a POLST form makes their wishes into a medical order that first responders must follow. In Washington it is co-sponsored by the Washington State Medical Association and the Department of Health, printed on distinctive bright green paper, and signed by both the person (or their surrogate) and a licensed clinician, an MD or DO, an ARNP, or a PA-C. POLST is not for every healthy adult. It is for people who are seriously ill or frail. Alongside it, every adult should have an advance directive, which names a health-care agent and states general wishes. The advance directive is a legal document, not an actionable medical order, so it does not replace the POLST. The two complement each other.
Qué decir
“My mother is seriously ill and we want her wishes followed if EMS is ever called. Can we complete a POLST form together, and can you sign it as her clinician?”
Qué esperar
The clinician reviews her wishes with you, fills out the POLST, and signs it with her or her surrogate. Keep the bright green original where it is easy to find, often on the fridge, and give copies to anyone who might call 911.
- Paso 2Understand the Medicare hospice benefit, what it is and what it is not
To start hospice, two physicians, the person's own doctor and the hospice physician, certify a prognosis of six months or less if the illness runs its normal course, and the person chooses comfort-focused care over curative treatment for the terminal illness. The benefit covers the hospice team, medications for the terminal illness, equipment and supplies, and grief support for the family before and after the death. It includes a respite benefit of up to five consecutive days of inpatient care to give the family caregiver a rest. What it does not cover is the room-and-board cost of an adult family home, assisted living, or a nursing home. The six months is not a hard cutoff. Benefit periods renew with recertification, and outliving the prognosis does not end coverage.
- Paso 3Know palliative care as the earlier option
Palliative care is comfort-focused symptom care, and it is available at any stage of a serious illness. Unlike hospice, it can run alongside curative treatment. Someone still pursuing a cure can get palliative care to manage pain, nausea, breathlessness, and stress at the same time. Hospice is the comfort care for the last months, once curative treatment for the terminal illness is stopped. If your person is not ready for hospice but is struggling with symptoms, ask their doctor about a palliative care referral now.
- Paso 4Know that Washington has a Death with Dignity law, stated plainly
Washington's Death with Dignity Act, chapter 70.245 RCW, lets a competent adult who is a Washington resident with a terminal disease request a prescription for medication the patient may self-administer to end their life. In the statute, a terminal disease means an incurable, irreversible, medically confirmed disease expected to produce death within six months. This is one option that exists under state law. Whether it is right for anyone is a deeply personal decision. If you or your person want to understand how the process works, the Department of Health has a Death with Dignity FAQ that walks through the steps.
- Paso 5Line up grief support, including the part that comes after
Grief support is part of the hospice benefit, not an extra. Medicare hospice covers bereavement support for the family for up to about thirteen months after the death, and it is one of the most underused parts of the benefit. You do not have to wait until after to use it, and you do not have to be in hospice to find grief support. Washington 211 can point you to local counseling and support groups. Reaching out early, even once, makes the later reaching out easier.
Lo que han aprendido otros cuidadores
Patterns families describe again and again, put into our voice. Not direct quotes.
- Many families say the same thing after hospice: they wish they had started weeks or months earlier. The fear was that hospice meant the end was days away. The relief was discovering it meant good days, managed symptoms, and a team that finally answered the phone.
- The families who kept the bright green POLST where a paramedic could find it, on the fridge or by the bed, are the ones whose person's wishes were actually honored when 911 was called. The directive filed away in a binder did not travel to the bedside.
- More than one family has described the shock of the first assisted living bill after starting hospice. Hospice paid for the nurse and the medications, but the rent kept coming. Knowing that ahead of time would have changed how they planned.
- Caregivers often describe the respite benefit as the thing that let them keep going. Five days where someone else held the weight, so they could sleep, was what made the months at home possible.
- Families who used the hospice grief support, including the months after the death, tend to say it mattered more than they expected. The ones who did not use it often did not know it was there, and free, the whole time.
Reunido de comunidades públicas de cuidadores. Es un resumen, no una cita textual.
Recursos locales para esto
The local support that matters most when care turns to comfort in your area.
- Hospice agency near you
A local hospice can explain the Medicare benefit in plain terms, do the certification with your person's doctor, and bring the team to wherever your person lives. Most will meet with you before you decide anything. There is no cost to ask questions.
- Long-Term Care Ombudsman
If your person is in an adult family home, assisted living, or a nursing facility, the Ombudsman is a free advocate for their rights and comfort, including at the end of life. They mediate and investigate, and they cost nothing. WA's statewide line is 1-800-562-6028.
Cuándo buscar a un profesional
Where to go for the official forms, the benefit details, and grief support.
For the POLST form and how it works in Washington, go to the WA POLST site run by the Washington State Medical Association and the Department of Health. For what hospice covers and how to start, the Medicare hospice benefit page lays it out. For grief and bereavement support, and to find local counseling and groups, Washington 211 can point you to help near you.
- Washington POLST (WSMA and DOH)
The bright green Portable Orders for Life-Sustaining Treatment form, plus guidance on who it is for and how to complete it.
- Medicare hospice benefit
What hospice covers, how the six-month certification works, the respite benefit, and grief support for the family.
- Washington 211
A searchable statewide directory for grief and bereavement support, counseling, and local groups. Free to use.