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Providing a loving embrace on a difficult journey for over 30 years.


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I am a Health Care Professional and would like Hope Hospice to contact me

or call our intake desk at  (830) 625-7525, Ext 221 or Fax to (830) 606-1388

*No-obligation consultations and assessments for families seeking information and care options.

Learn more about our new Cardiac Care Program

I am a Health Care Professional

Why trust Hope Hospice with your patient’s care? 

At Hope Hospice we are very proud of our 30 year legacy and expertise of providing exceptional care to over 10,000 patients and their families in our community.  Our highly skilled team of doctors, nurses, chaplains, social workers, volunteers and certified nursing assistants provide holistic, all-encompassing care and our professional adult and children grief counselors are there for families for as long as needed.  Hope Hospice believes that hospice is a choice for patients who have a life-limiting illness and have decided it is time to focus on the quality of their lives. Hope recognizes that every person’s experience will be different so our hospice team creates a plan of care according to the individual needs and wishes of each patient. Our care emphasizes alleviating pain, enhancing quality of life and helping to make each day as full as possible.


  • Board Certified Hospice and Palliative Care Medical Director
  • Nationally recognized adult and children’s grief program led by licensed professional counselors
  • Expert staff trained in preventing medical crises and hospitalizations
  • Specially trained Cardiac Care Team
  • Low nurse to patient ratios
  • Easy referral process, quick response time and best in class service
  • Non-profit, community owned agency dedicated to reinvesting 100% of operating margin into patient care
  • 11th Hour Volunteer services ensuring no one dies alone
  • CHAP accredited
  • We Honor Veterans Partner

Three Easy Ways to Refer

  1. Call Intake Desk (830) 625-7525, ext 221
  2. Fax to (830) 606-1388
  3. Submit inquiry online for us to call you (see top left hand corner of page)

What to Send

  • Face Sheet
  • History and physical
  • Relevant progress notes, imaging and labs
  • Medication administration record
  • MD order to “evaluate and admit if appropriate”

Levels of Care

Routine for well-managed symptoms
Respite gives families a break
Crisis Care for when symptoms are out of control
General In-Patient for acute symptom management

Areas Served

Comal (Bulverde, Canyon Lake, Garden Ridge, New Braunfels, Spring Branch, Startzville, Sattler)
Hays (San Marcos, Wimberley, Martindale, Kyle, Woodcreek)
Guadalupe (Cibolo, Geronimo, Kingsbury, Marion, McQueeney, New Berlin, Schertz, Seguin, Luling)
Bexar (Converse, Live Oak, Selma, Windcrest, Universal City)

We will consider patients living outside of coverage area on a case by case basis.


  • Registered Nurse Home Care visits/24 Hour RN On Call
  • Certified Nursing Assistant/Homemaker services
  • Medicines per diagnosis
  • Prescription delivery
  • Medical supplies/equipment
  • Nutritional supplements/Dietary counseling
  • Emotional and Spiritual Support
  • Volunteer Services
  • Physical/Speech Therapy
  • Massage Therapy
  • Pet Therapy
  • Wound Specialist
  • Extended Grief Support for Children and Adults

Insurances Accepted

  • Medicare
  • Medicaid
  • All Medicare Advantage Plans (MAPs)
  • Private Insurance
  • Community Assistance Program is available for underfunded or unfunded patients

Signs to Look For

We can do in-home assessments to assist in determining whether hospice is a good fit. Call us if you see:

  • Multiple hospitalizations/ER visits
  • Recurrent infections
  • Decline in ability to complete daily activities
  • Co-morbidities
  • Unintentional weight loss or gain
  • Frequent falls or change in ambulatory status
  • Change in oxygen saturation

Still not sure if your patient is ready for hospice?

No problem. We offer free, no obligation consultations and assessments for families seeking information and care options.



Supporting documentation may include:

  1. Clinical findings of malignancy with widespread, aggressive or progressive disease as evidenced by increasing symptoms, worsening lab values and/or evidence of metastatic disease
  2. Palliative Performance Scale 70% or less
  3. Refuses further life-prolonging therapy OR continues to decline in spite of definitive therapy
  4. Hypercalcemia > 12
  5. Cachexia or weight loss of 5% in past 3 months
  6. Recurrent disease after surgery/radiation/chemotherapy
  7. Signs and symptoms of advanced disease (e.g. nausea, requirement for transfusions, malignant ascites or pleural effusion, etc.)

Stroke or Coma

Supporting documentation may include:

  1. Karnofsky Performance Status Scale from 40% or less
  2. Palliative Performance Scale 40% or less
  3. Body Mass Index less than 22 kg/m2
  4. Unintentional weight loss (despite tube feeding) 10% in 6 months or 7.5% in last 3 months
  5. Dysphagia without tube feeding
  6. Pulmonary aspiration not responsive to speech pathology intervention
  7. Serum albumin 2.5 gm/dl or less
  8. Age greater than 70
  9. Post stroke dementia, with FAST score of 7C or greater
  10. Medical complications related to progressive clinical decline over past 12 months
    • Aspiration pneumonia
    • Pyelonephritis
    • Sepsis
    • Skin breakdown, decubitus ulcers, refractory stage 3-4


Supporting documentation may include:

  1. Karnofsky Performance Status Scale 70% or less
  2. Palliative Performance Scale 70% or less
  3. Body Mass Index less than 22 kg/m2
  4. Unintentional weight changes
  5. Increased frequency of respiratory infections
  6. Presence of cor pulmonale or right heart failure
  7. Oxygen saturation less than 88% on room air
  8. PCO2 greater than or equal to 50mm Hg
  9. Disabling dyspnea at rest/minimal activity in spite of continuous oxygen
  10. Unresponsive or poorly responsive to bronchodilators, despite optimum medication management
  11. Increased frequency of ER visits or hospitalizations for symptom control
  12. Increasing dependence on others for ADLs

Neurological (CVA, ALS, Parkinsons)

The two critical factors in determining prognosis are the ability to breathe and to swallow. Supporting documentation may include:

  1. Patient chooses not to elect tracheostomy and invasive ventilation
  2. Critically impaired ventilatory capacity
    • Vital Capacity less than 40% of predicted (seated or supine)
    • Significant dyspnea at rest
    • Use of accessory respiratory musculature
    • Requiring oxygen at rest/minimal activity
    • Respiratory rate > 20
    • Reduced speech/vocal volume
  3. Severe nutritional deficiency
  4. Dysphagia with progressive weight loss of at least 5% of body weight


Supporting documentation may include:

  1. Patient has all the following characteristics:
    • Stage 7 or beyond according to the FAST Scale
    • Unable to ambulate without assist
    • Unable to dress without assist
    • Unable to bathe without assist
    • Urinary and fecal incontinence intermittent or constant
    • No meaningful verbal communication: stereotypical phrases only or the ability to speak is limited to six or fewer intelligible words
  2. The following may have occurred in the past 12 months:
    • A spiration pneumonia
    • Pyelonephritis or other UTIs
    • Septicemia
    • Pressure ulcers, multiple stage 3-4
    • Recurrent fever after antibiotics
    • 10% weight loss or serum albumin<2.5 gm/dl within the last 6 months

Cardiac Disease

Supporting documentation may include:

  1. New York Heart Association (NYHA) Class IV
  2. Ejection fraction of 20% or less
  3. Decline in Karnofsky Performance Status Scale from 70% or less
  4. Palliative Performance Scale from 70% or less
  5. Unintentional weight loss or gain (Weight gain could be from fluid overload, not representing nutritional status)
  6. Shortness of breath or angina at rest/minimal activity
  7. Symptoms persist even with optimal dose of diuretics, vasodilators, and/or ACE inhibitors
  8. Not a candidate for or declined surgical procedures
  9. Increased frequency of ER visits or hospitalizations for symptom control
  10. Current inotropic therapy dose unable to be reduced
  11. Dependence in 2 or more ADLs


Supporting documentation may include:

  1. CD4+ count below 25 cells/mcL measured when a patient is relatively free from acute illness but should be followed clinically and observed for disease progression and decline in recent functional status
  2. Patients with a persistent HIV RNA (viral load) of > 100,000 copies/ml may have a prognosis less than 6 months
  3. Patients who have elected to forego anri-retroviral medication
  4. Karnofsky Performance Status Scale from below 50%
  5. Palliative Performance Scale below 50%

Generally, anri-retroviral therapies such as protease inhibitors are considered lifeprolonging.

Liver Disease

Supporting documentation may include:

  1. Karnofsky Performance Status Scale from 70% or less
  2. Palliative Performance Scale 70% or less
  3. Body Mass Index less than 22 kg/m2
  4. Unintentional weight loss or gain
  5. Both prothrombin time > 5 see over control or INR > 1.5 and serum albumin < 2.5 gm/dl
  6. End stage liver disease:
    • Ascites unresponsive to treatment
    • Spontaneous bacterial peritonitis
    • Jaundice; hepatic encephalopathy
    • Recurrent variceal bleeding
    • Muscle-wasting with reduced ADLs
    • Hepatorenal syndrome (elevated creatinine, BUN and oliguria (400 cc/24hr) and urine sodium concentration (less than 10 meq/L)

Renal Disease

Supporting documentation may include:

  1. Karnofsky Performance Status Scale from 70 or less
  2. Palliative Performance Scale 70% or less
  3. Body Mass Index less than 22 kg/m2
  4. Unintentional weight loss or weight gain
  5. Creatinine clearance < 10 cc/min or < 15 cc/min for diabetics
  6. Serum creatinine > 8.0 mg/dl or 6.0 mg/dl for diabetics
  7. Oliguria: Urine output less than 400 cc/24hr
  8. Uremia: clinical symproms of renal failure
    • Confusion
    • Nausea/vomiting
    • Generalized pruriris
    • Restlessness
  9. Not seeking dialysis, needed transplant or is discontinuing dialysis