Hospice Timeline Reconstruction Tool
A structured template for rebuilding the patient’s end‑of‑life timeline, identifying delays, and highlighting deviations from hospice standards of care.
Hospice Timeline Reconstruction Tool
Hospice cases often turn on the sequence of events: when symptoms escalated, when hospice was notified, how quickly interventions were provided, and whether care aligned with the patient’s goals. This tool helps attorneys reconstruct the patient’s clinical and communication timeline with clarity, identify delays, and expose deviations from expected hospice care.
Use this tool during case screening, breach analysis, expert review preparation, and deposition strategy.
Baseline Timeline
✔ Establish Baseline
Admission date and time
Setting (home, facility, inpatient hospice)
Primary diagnosis
Baseline symptom profile
Baseline functional status
Baseline cognitive status
Advance directives / POLST / MOST
Identified decision-maker
✔ Identify Initial Risks
Pain
Dyspnea
Agitation
Delirium
Skin breakdown
Hydration/nutrition concerns
Admission & Initial Visit Timeline
✔ Document Key Events
Admission assessment
Initial symptom evaluation
Medication reconciliation
Goals-of-care discussion
Family education
Initial plan of care
✔ Identify Delays
Late admission visit
Missing initial assessment
No documented goals-of-care discussion
No medication review
Ongoing Visit & Symptom Monitoring Timeline
✔ Nursing Visits
Visit dates and times
Symptom assessments
Medication administration
Reassessment after interventions
✔ Provider Involvement
Physician/NP visits
Medication changes
Symptom-management decisions
✔ Interdisciplinary Team (IDT) Notes
Care plan updates
Communication between disciplines
✔ Identify Gaps
Missed visits
No reassessment after medication
Contradictory documentation
No IDT updates despite changes
Symptom Escalation Timeline
✔ Reconstruct the Escalation Event
Time symptoms worsened
Who noticed the change
When hospice was notified
Time of hospice response
Interventions performed
Medication adjustments
Family communication
✔ Identify Delays
Delayed recognition of worsening symptoms
Delayed hospice response
Delayed medication titration
No reassessment after interventions
Active Decline & End-of-Life Timeline
✔ Required Elements
Time active decline was first recognized
Visit frequency during decline
Symptom-management interventions
Family updates
Emotional/spiritual support
Medication adjustments
Time of death
✔ Identify Red Flags
No increase in visit frequency
Uncontrolled symptoms
Family reports being unprepared
No documentation of end-of-life education
Communication Timeline
✔ Document All Communication
Family calls to hospice
Hospice responses
Provider updates
IDT communication
Education provided
Changes in goals of care
✔ Identify Failures
Family reports “no one told us”
Delayed callbacks
No documentation of updates
Care plan not adjusted despite changes
Timeline Red Flags (Breach Indicators)
These are the most common breach themes in hospice litigation.
Missed or delayed visits
Uncontrolled pain or dyspnea
Delayed symptom-management interventions
Delayed medication titration
Poor communication with family
No anticipatory guidance
Documentation gaps or contradictions
Failure to recognize active decline
Care inconsistent with goals of care