Whether You Need a DNR to Get Hospice
SaveA do-not-resuscitate order and a hospice election are two different documents that people often confuse. One is a medical order about whether to attempt CPR. The other is a choice to shift the goal of care toward comfort. You can have either without the other, and Medicare's hospice rules do not list a DNR among their requirements.
Last updated: July 2026
Do you need a DNR to go on hospice?
No. A do-not-resuscitate order is not required to elect the Medicare hospice benefit. The benefit has clear conditions — a person must be entitled to Medicare Part A and be certified by a physician as terminally ill 1Ref 1Centers for Medicare & Medicaid Services (2024).Hospice (Fee-for-Service Providers).To use the hospice benefit a beneficiary must be entitled to Medicare Part A and be certified as terminally ill; these are the entitlement and certification conditions of the benefit. — and it centers on choosing comfort-focused care rather than treatment aimed at curing the terminal illness 2Ref 2Centers for Medicare & Medicaid Services (2024).Hospice Care Coverage.Electing hospice means curative treatment for the terminal illness stops while comfort care is covered; room and board is generally not covered; these are the eligibility and coverage conditions, which do not include a DNR.. A DNR appears nowhere in that list.
The confusion is easy to understand. Hospice and DNR orders both come up near the end of life, often in the same conversation, so they blur together. But they answer different questions. Hospice is about the overall goal and setting of care. A DNR is about one specific action — whether to attempt resuscitation if the heart or breathing stops.
What Medicare actually requires to elect hospice
Three things establish the Medicare hospice benefit, and a DNR is not among them. First, the person must be entitled to Medicare Part A 1Ref 1Centers for Medicare & Medicaid Services (2024).Hospice (Fee-for-Service Providers).To use the hospice benefit a beneficiary must be entitled to Medicare Part A and be certified as terminally ill; these are the entitlement and certification conditions of the benefit.. Second, a physician certifies that the illness is likely to be terminal within about six months if it runs its normal course — the terminal-status documentation clinicians assemble to support that prognosis 3Ref 3Centers for Medicare & Medicaid Services (Medicare Administrative Contractor LCD) (2023).Local Coverage Determination (LCD): Hospice - Determining Terminal Status (L33393).Clinicians document terminal status using defined criteria to support a prognosis of six months or less.. Third, the person signs an election choosing comfort-focused care instead of curative treatment for the terminal illness 4Ref 4Centers for Medicare & Medicaid Services (2024).Medicare and Hospice Benefits: Getting Started (CMS Product No. 11361).A person starts hospice by electing comfort-focused care rather than curative treatment for the terminal illness, and the hospice team builds a plan around that goal..
That is the whole gate. Whether someone is full code or has a DNR is not one of these eligibility conditions 2Ref 2Centers for Medicare & Medicaid Services (2024).Hospice Care Coverage.Electing hospice means curative treatment for the terminal illness stops while comfort care is covered; room and board is generally not covered; these are the eligibility and coverage conditions, which do not include a DNR.. A person can complete every hospice requirement and still keep full code status, at least as far as the Medicare rules are concerned. What their own hospice agency then discusses with them is a separate matter of practice, not a federal requirement.
What a DNR is, and why it's a different decision
A DNR is a medical order that tells clinicians not to attempt cardiopulmonary resuscitation if the heart stops or breathing ceases. It addresses that single moment and that single intervention. Hospice, by contrast, is an entire model of team-based care focused on comfort and dignity for someone with a life-limiting illness 5Ref 5MedlinePlus, U.S. National Library of Medicine (2024).Hospice Care.Hospice is team-based end-of-life care focused on comfort and dignity, an overall model of care rather than a single medical order.. One is a narrow instruction; the other is a wholesale approach to care.
Because they are separate, all of the combinations exist. A person can be on hospice and remain full code. A person can have a DNR while still pursuing aggressive treatment and not be on hospice at all. Code status versus hospice eligibility are simply two different questions, decided on different grounds and at different moments.
Why people think a DNR is required
The belief comes from what happens in practice, not from the rules. Hospice teams routinely discuss goals of care when someone enrolls, and the plan they build is comfort-focused rather than curative 4Ref 4Centers for Medicare & Medicaid Services (2024).Medicare and Hospice Benefits: Getting Started (CMS Product No. 11361).A person starts hospice by electing comfort-focused care rather than curative treatment for the terminal illness, and the hospice team builds a plan around that goal.. Code status naturally comes up in that conversation, and some agencies raise it early, so families can leave with the impression that signing a DNR was part of joining.
Agencies also differ in how they approach these conversations, which is one more reason to compare hospices before choosing one. Family-reported experiences vary, including by hospice ownership, with caregivers reporting different experiences at for-profit versus not-for-profit agencies 6Ref 6Anhang Price R, Parast L, Elliott MN, et al. (2023).Association of Hospice Profit Status With Family Caregivers' Reported Care Experiences.Family caregivers report different care experiences at for-profit versus not-for-profit hospices, so agencies differ in the care they deliver.. How an agency handles goals-of-care and code-status discussions is a fair thing to ask about when you are deciding when to choose a hospice.
What electing hospice does change
The real trade-off in choosing hospice is not about resuscitation; it is about the direction of treatment. When a person elects hospice, treatment aimed at curing the terminal illness is set aside, and the hospice benefit covers care focused on comfort instead 2Ref 2Centers for Medicare & Medicaid Services (2024).Hospice Care Coverage.Electing hospice means curative treatment for the terminal illness stops while comfort care is covered; room and board is generally not covered; these are the eligibility and coverage conditions, which do not include a DNR.. Symptom treatment continues and often intensifies; what stops is the pursuit of a cure for that particular illness 4Ref 4Centers for Medicare & Medicaid Services (2024).Medicare and Hospice Benefits: Getting Started (CMS Product No. 11361).A person starts hospice by electing comfort-focused care rather than curative treatment for the terminal illness, and the hospice team builds a plan around that goal..
Some practical limits come with the benefit too — room and board in a home or facility is generally not covered by the hospice benefit itself 2Ref 2Centers for Medicare & Medicaid Services (2024).Hospice Care Coverage.Electing hospice means curative treatment for the terminal illness stops while comfort care is covered; room and board is generally not covered; these are the eligibility and coverage conditions, which do not include a DNR.. None of these changes is a DNR. They describe a shift in the goal of care, which is a different thing from an order about CPR, and it can be made whatever a person decides about resuscitation.
Deciding about resuscitation on your own terms
Because code status is separate, it stays the person's decision, made with their clinicians and revisited as things change. Being on hospice does not force a do-not-resuscitate order onto anyone. Many people on hospice do choose one, because attempting resuscitation can run counter to a plan built around comfort — but that choice is theirs, and it is made apart from the hospice election itself.
The same logic runs the other way, much as being able to walk has nothing to do with eligibility. Just as prognosis rather than function decides hospice — a distinction sometimes framed as prognosis versus function — code status rather than paperwork decides resuscitation. Keeping the two questions apart lets each be answered honestly, on its own terms.
How a crisis is handled, with or without a DNR
What actually changes the response in a crisis is the plan, more than any single order. Under hospice, the comfort-focused plan means the 24-hour hospice line is the first call when symptoms flare, rather than a reflexive trip to the emergency room 4Ref 4Centers for Medicare & Medicaid Services (2024).Medicare and Hospice Benefits: Getting Started (CMS Product No. 11361).A person starts hospice by electing comfort-focused care rather than curative treatment for the terminal illness, and the hospice team builds a plan around that goal.. Care is delivered wherever the person lives — at home or in a facility — by a team organized around comfort 5Ref 5MedlinePlus, U.S. National Library of Medicine (2024).Hospice Care.Hospice is team-based end-of-life care focused on comfort and dignity, an overall model of care rather than a single medical order..
A DNR is narrower than that. It tells clinicians whether to attempt CPR at the moment the heart or breathing stops; it does not, by itself, redirect the rest of a crisis. That is why some people keep full code status on hospice yet still rely on the hospice plan for everything short of resuscitation. The plan and the code-status order are separate levers, and choosing hospice sets the first without dictating the second. Knowing which lever is which — the comfort plan on one side, the resuscitation order on the other — is what keeps a family from feeling that electing hospice quietly signed away a decision they never actually made.
Common questions
Related
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What Comfort Care and Full Code Mean at the Bedside
Say it back
How would you explain this to someone you love?
Two or three sentences, just as you’d say it. Gale reflects back what you focused on — a mirror, not a quiz.
When to call the hospice team
- —Pain, breathlessness, or agitation that the current comfort plan is no longer controlling
- —Confusion about the code-status or resuscitation plan while a crisis is unfolding at home
- —A sudden change in breathing, alertness, or color in someone whose care plan you are unsure of
The hospice's phone line is staffed 24 hours a day and is the first call when symptoms escalate or the plan is unclear. Call 911 only for an emergency the person has not planned for, or when you do not know whether a DNR or other order is in place.
This article explains how a DNR and the Medicare hospice benefit differ. It is general information, not medical or legal advice, and decisions about code status and hospice should be made with the person's physician and hospice team.
References
- 1.Centers for Medicare & Medicaid Services (2024). Hospice (Fee-for-Service Providers). Centers for Medicare & Medicaid Services (CMS). link ✓To use the hospice benefit a beneficiary must be entitled to Medicare Part A and be certified as terminally ill; these are the entitlement and certification conditions of the benefit.
- 2.Centers for Medicare & Medicaid Services (2024). Hospice Care Coverage. Medicare.gov (CMS). link ✓Electing hospice means curative treatment for the terminal illness stops while comfort care is covered; room and board is generally not covered; these are the eligibility and coverage conditions, which do not include a DNR.
- 3.Centers for Medicare & Medicaid Services (Medicare Administrative Contractor LCD) (2023). Local Coverage Determination (LCD): Hospice - Determining Terminal Status (L33393). CMS Medicare Coverage Database. link ✓Clinicians document terminal status using defined criteria to support a prognosis of six months or less.
- 4.Centers for Medicare & Medicaid Services (2024). Medicare and Hospice Benefits: Getting Started (CMS Product No. 11361). Medicare.gov (CMS). link ✓A person starts hospice by electing comfort-focused care rather than curative treatment for the terminal illness, and the hospice team builds a plan around that goal.
- 5.MedlinePlus, U.S. National Library of Medicine (2024). Hospice Care. MedlinePlus (U.S. National Library of Medicine, NIH). link ✓Hospice is team-based end-of-life care focused on comfort and dignity, an overall model of care rather than a single medical order.
- 6.Anhang Price R, Parast L, Elliott MN, et al. (2023). Association of Hospice Profit Status With Family Caregivers' Reported Care Experiences. JAMA Internal Medicine. doi:10.1001/jamainternmed.2022.7076 ✓Family caregivers report different care experiences at for-profit versus not-for-profit hospices, so agencies differ in the care they deliver.
6 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy