Evidently all hospices are not the same with regard to the need for the family's choosing an appropriate outside "local doctor" as Betsy describes. In our case, once our family doctor (not the neurologist who'd been treating my DW's AD symptoms for the previous seven or eight years) suggested and initiated a "hospice consult" when it became impractical for me to continue bringing my DW in for lab work (to diagnose recurring UTIs, etc.), Vitas Hospice had us signed up before the day was over, we were seen by a hospice nurse the next day, then a hospice doctor the following day, then a social worker, then a chaplain, etc. As far as I know, neither our PCP nor our neuro had any further input as to treatment, although I suppose the hospice doctor could have consulted with them initially. But bottom line, we received outstanding "comfort care" and assistance that allowed us to keep my DW here at home during her final three months, and the Haitian chaplain was a real blessing in coming out every week to sing and pray with my DW -- she loved it so much that we asked him to lead her memorial service.

I had Hospice in my home twice in the past 2 1/2 years. First was 6 months for my Mom and second was 12 days with my husband a year ago. In both instances our PCP continued to be their Doctor during the Hospice period. Our PCP suggested I call them for my Mom and they admitted her to their program immediately. I called the same Hospice group for my husband since I had such good results with them the first time. They tentatively enrolled him in their program and then called our PCP themselves. Things went very smoothly for us. When the Hospice Nurse had any question about med adjustment or change she called our PCP who was very familiar with their Medical History and also mine. She did not make any med changes without consulting our PCP.

Sometimes things progress rather quickly and if you are in late mid stages you would be wise to make a tenative decision about a Hospice Group in your area. My husband skipped stage 7 all of a sudden and it was good that I had called them for an evaluation 4 days before he became unresponsive. Do not "fear" calling them or making a decision about which Company you want to have nor pre-choosing a NH so if you suddenly have to make "the decision" you will be more comfortable doing so. The same goes for pre-writing obituaries. You will have many things to do one day and the more you can get done now the easier - later - will be. Take care...you are in charge...