Caught in the Crossfire: What to Do When Families Request to Stop Feeding a Hospice Resident

As an assisted living facility (ALF) operator, you’re no stranger to difficult and emotionally charged situations. One issue that has recently surfaced involves families requesting that a resident on hospice care stop being fed—despite the resident still being physically capable of eating. This request places facilities in an incredibly challenging position, balancing family wishes, the resident’s well-being, and strict regulatory compliance.

Assisted living facilities are bound by laws and ethical guidelines to provide appropriate care to residents, including ensuring their nutritional needs are met. When a family requests that feeding be stopped, it raises questions about how to respond while respecting the resident’s rights and adhering to regulations. Without clear medical justification, ceasing to provide food could be seen as neglect, putting the facility at legal and ethical risk.

•ALFs must provide food and hydration unless there is documented medical guidance that justifies stopping. Simply acting on a family’s verbal request to withhold food is not sufficient.

•Residents retain the right to be fed if they are still capable of eating, unless they themselves have refused food.

•Hospice care is centered on comfort and dignity at the end of life. However, hospice recommendations should always be documented. If hospice professionals believe feeding should cease for medical reasons, they should provide a written care plan or directive that outlines why.

•While family members are often acting in what they believe is the resident’s best interest, facilities must clarify that such requests need to align with medical guidance and state regulations.

•The facility should communicate openly and compassionately, explaining its obligations and the need for proper documentation.

•If a family requests that feeding stop, the first step is to involve the hospice team. Request an immediate assessment of the resident’s condition and any written guidance regarding feeding.

•If hospice agrees with the family’s request, they must provide proper documentation that outlines the medical rationale.

•The resident’s physician should be contacted to determine if there are any medical concerns with continuing to feed the resident. If there is no documented risk, feeding should continue.

•Explain that the facility cannot legally or ethically stop feeding a resident who is still capable of eating unless there is clear medical documentation supporting the decision.

•Emphasize the facility’s role in ensuring the resident’s rights and well-being.

•Record all family conversations, hospice recommendations, and medical input. Ensure the care plan reflects any changes or clarifications in feeding protocols.

•Train staff to recognize and navigate these sensitive situations. They should understand the legal and ethical guidelines surrounding food and hydration in hospice care.

•A resident who is capable of eating retains the right to be fed. Facilities must prioritize the resident’s needs over family requests unless there is medical justification to act otherwise.

•Ceasing to feed a resident without clear medical guidance could be viewed as neglect, violating both state regulations and ethical standards.

•Regulations vary by state, but in general, facilities must ensure that residents’ nutritional needs are met unless a physician or hospice team provides documentation to the contrary.

•Proactively Update Care Plans: Ensure care plans for residents on hospice are regularly reviewed and include clear instructions regarding feeding.

•Educate Families: Provide families with resources and information about hospice care and facility responsibilities to prevent misunderstandings.

•Build Strong Relationships with Hospice Providers: Work closely with hospice teams to streamline decision-making and documentation.