The conversation usually starts at home
Families often notice a change before anyone uses the word hospice. Hospital stays become closer together. Eating and drinking drop off. Walking to the bathroom takes more help. Pain or shortness of breath is harder to settle. The person spends most of the day in bed or a chair.
None of these signs, by themselves, proves that hospice is appropriate. They are reasons to ask the doctor a direct question: would comfort-focused care help now?