Early Intervention (Pre-Hospice)

Hospice care is a collection of health care services designed to maximize comfort for a person who is terminally ill. A person of any age is eligible to receive hospice care (which is usually paid for by Medicaid/Medicare/private insurance) when a physician certifies that the person is likely to live for six months or less, depending on how their disease progresses. But what if you or your loved one does not qualify for hospice care, yet needs additional care and end-of-life planning services?

Early involvement or pre-hospice covers a broad range of services, ranging from diagnosis research and processing to future care planning and companionship services for every step between. Some examples of early involvement care are:

  • (1) The client is in a long-term care facility and suffering from mental debilitation as a result of a stroke and has been recently diagnosed with (late stage) Congestive Heart Failure. Because of his stroke, he is having difficulty understanding and processing his diagnosis. The end-of-Life doula assisted the client by white-boarding his diagnosis and having twice-weekly conversations where the diagnosis and prognosis were consistently and repeatedly explained.
  • (2) The client is in a long-term care facility and suffering from dementia. The end-of-life doula assisted the client with bi-weekly companionship visits, engaging with the client in her favorite activities, such as praying the rosary, reading aloud from beloved books, playing favorite hymns and offering physical touch such as hand massage and nail painting.
  • (3) The client is living with his daughter and her family when he receives a cancer diagnosis. Although his prognosis is not terminal, the client wishes to move to a nursing care facility before any physical or cognitive decline, while he undergoes treatment. The end-of-life doula guides the family in researching care facilities in the local community, tours the communities with the family to offer advice on the suitability of the facility, as well as provides assistance and companionship throughout the move itself and the following treatment. The doula provides companionship and visitation services after the client has been relocated to add an additional layer of advocacy, comfort and interaction. The doula also assists throughout the treatment in helping advocate that the client receives exactly the care he envisions.
  • (4) The client is of retirement age and living alone when she receives a diagnosis of Parkinson’s Disease. Although she is in good health and still living independently, the client would like to record wishes for advanced care as well as begin to consider the legacy work she wishes to eventually leave for her loved ones. The doula assists in advance care planning and recording of final wishes as well as determining the most meaningful legacy projects to leave to her children. In this situation, the legacy project was recording milestone videos for the client’s children and grandchildren.

These four examples illustrate the wide variety of ways a doula can serve clients who are not eligible for hospice but who may be recently diagnosed or currently undergoing treatment for a serious illness. Early intervention can be a simple as companionship – an ally to help a recenlty diagnosised person understand the intricaies of their prognosis and provide ear to listen and a mind to help research. Early intervention can be as complicated as assisting in the transition from independent living to care facilities. Early intervention can be every step in between.

To discuss which early intervention (pre-hospice) services best suit you or your loved one, reach out to me at jade.adgate@farewellfellowship.com.

For more information regarding the Early Intervention, pre-Hospice or “Transitions” movement, please see:



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