In the United States, the number of decedents utilizing hospice services has increased during the last decade. At the same time, the number of deaths occurring in an acute care hospital declines, but late hospice referrals and high levels of burdensome interventions at the end of life persist. This is for example shown in the higher number of patients who had hospice services for shorter than 3 days before death, while use of intensive care during the last 30 days of life increased. The point is that in the case of late admission to a hospice, patients are nor served well. In the last days of life patients often have unrelieved physical suffering and strong emotional, spiritual, and social distress. To deliver quality of care and a good care plan, it is needed to recognise that a person is entering the terminal phase of his disease to shift to comfort care in time. If patients at the end of life are not recognized as dying, it results in suffering, which may not be properly managed.
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