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 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‑make
✔ 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
These delays are often the strongest breach indicators.
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)
• 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
These are the most common breach themes in hospice litigation.