Hospice Care After a Stroke in Metro Detroit

Updated September 2026. Written and reviewed by the Lily Hospice clinical team.

Hospice after a stroke is for the person who is not recovering: swallowing has failed, pneumonia keeps returning, or the hospital has asked about goals of care. Lily brings nursing, equipment, aide help and family teaching to any home in Oakland, Macomb or Wayne County, usually within a day.

In Medicare’s most recent Care Compare data, 71.3% of Lily Hospice patients were visited by a nurse or social worker in their last three days of life, against a national average of 48.3% and a metro Detroit median of 60.9% across the 104 hospices serving Oakland, Macomb and Wayne counties. You can read every one of our published scores, including the ones we are still working on.

A stroke arrives in a single afternoon and then asks a family to make decisions for months. Your mother was fine at breakfast in Sterling Heights; by evening she was in an emergency room, and within a week someone at the hospital said “goals of care.” Or the stroke was two years ago, she came home from rehab with a cane, and only in the last few months has she stopped eating well, started choking on thin liquids, and been back in the hospital twice with pneumonia. Both families are asking the same question, and it is the right one: is this the time to call hospice?

Two paths families face after a stroke

The sudden, severe stroke. Some strokes are so large that recovery is not expected. The person may be unable to swallow, speak or wake fully, and the hospital team, often at a comprehensive stroke center such as Corewell Health William Beaumont University Hospital in Royal Oak, Henry Ford Hospital, Henry Ford St. John, Henry Ford Providence Novi or DMC Detroit Receiving, asks the family what the person would have wanted. Hospice can begin directly from the hospital, at home or in a facility, sometimes within hours. Same-day hospice admission explains how, including on weekends.

The slow decline months or years later. More common is the person who survived a stroke, went through rehabilitation at a place like the Rehabilitation Institute of Michigan in Detroit or a neurological rehab clinic in Royal Oak, and plateaued. Over time the family notices swallowing trouble, repeated aspiration pneumonia, weight loss, pressure sores, a person who sleeps most of the day and no longer recognizes people, and therapists who gently say there is nothing more to gain. The decline is slow enough that families rarely see the moment it became a hospice question. Most tell us afterward that they wish they had called sooner.

Signs it may be time to talk about hospice

Neurologists use scales and scores, and the physician makes the eligibility decision. What families notice is simpler:

Trouble swallowing: coughing or choking with food or drink, meals that take an hour, or a recommendation for thickened liquids or a feeding tube
Two or more hospital stays for pneumonia, urinary infection or dehydration in the last six months
Losing weight even with careful feeding, or losing muscle in the arms and legs
Sleeping most of the day, and awake but not really present when up
No longer recognizing family, or no longer responding to voices in the room
Pressure sores on the heels, hips or tailbone that keep coming back
Rehabilitation stopped because the person is no longer making progress
Living in a nursing home or memory care after the stroke, with each month a little harder than the last
The person has said, in words or with a look, that they are tired of hospitals

If several of these feel familiar, it is not too early to ask. If you are still unsure, Is It Time? A Family’s Gentle Guide to Hospice walks through the question without pressure.

What hospice does for someone after a stroke

Swallowing made safer and gentler. The nurse and, when it helps, a speech therapist teach the family how to position, pace and choose foods so that meals bring comfort instead of coughing. When eating stops being safe or wanted, the team explains what that means and what comfort looks like, without rushing anyone toward a decision.

Skin protected and pain managed. A hospital bed with a pressure-relieving mattress, a turning schedule the family can actually keep, wound care for existing sores, and medication for the pain and stiffness that often follow a stroke, all delivered to the home and covered under the Medicare hospice benefit.

A way to communicate when speech is gone. Many stroke patients understand far more than they can say. Our team helps families find yes-and-no signals, picture boards, hand squeezes and simple routines, and treats the person as present in every conversation held in the room.

Support for the whole household. Aide visits for bathing and personal care, a social worker for paperwork and family meetings, a chaplain for families of any faith or none, volunteers for company, and bereavement support afterward. One number, (248) 955-5100, reaches a real person at any hour. Who answers at night.

Feeding tubes, fluids and hard choices

The feeding-tube question is the one stroke families most often carry alone, and it should not be. Some had a tube placed during the acute stroke and are asking whether to continue it; others are being asked whether to place one now that swallowing has failed. There is no single right answer. What we can promise is an honest conversation with the physician about what a tube can and cannot do for this person, what comfort feeding looks like, how thirst and hunger are actually experienced near the end of life, and how the family will be supported in whichever choice they make. The decision stays with the family and the patient, and it can be revisited.

What the first weeks look like

Within a day of your call, usually the same day, a nurse visits wherever your loved one is: home, rehab, a nursing home or a hospital room. Our team handles the physician’s referral and the Medicare election, and the first visit sets up the plan of care, the comfort kit and the equipment order; the bed, mattress and supplies typically arrive within a day or two. What happens on the first hospice visit.

In the first week the nurse visits several times to settle symptoms and to teach: how to give medicines, how to turn and position, how to feed safely, when to call. The aide begins bathing visits. The social worker meets the family and sorts out Medicare, Medicaid or facility questions. From then on the rhythm is set by need: at least weekly nursing, more when symptoms change, and daily or more toward the end. How long hospice lasts.

Hospice in skilled nursing, rehab step-down and memory care

Many stroke patients are not at home. They are in skilled nursing after rehab ended, in memory care because the stroke brought on or worsened dementia, or in assisted living with a spouse who can no longer manage transfers. Hospice comes to all of these. The facility keeps providing room, board and daily care; Lily adds the nurse, aide, social worker, chaplain, medications, equipment and the around-the-clock phone line, and coordinates with facility staff so nobody works from two plans. How hospice works inside a facility. Where the stroke has led to dementia-like changes, our dementia hospice page describes what families see and what helps.

When the caregiver is a spouse

After a stroke, the caregiver is very often a husband or wife in their eighties, lifting, turning, feeding and getting up at night. Hospice is built for that household: the aide takes over bathing, equipment makes transfers safer, volunteers give an afternoon off, and respite care offers up to five days in a facility so the spouse can rest. When the person on hospice lives alone, the plan is built differently: hospice when your parent lives alone.

Talk it through with a nurse, day or night

You do not have to decide anything on the phone. Call (248) 955-5100 and a real person answers, 24 hours a day. We can visit for a no-obligation evaluation, usually within a day, including evenings and weekends, and if hospice is not the right fit yet, our Pathways palliative program may be. If you are comparing hospices, our provider-neutral metro Detroit hospice directory lists every Medicare-certified hospice in the three counties.

Common questions

Can hospice start while she is still in the hospital after the stroke?

Yes. Many stroke patients are admitted to hospice directly from the hospital, either going home with the hospice team already in place or moving to a facility with hospice following. We coordinate with the hospital’s discharge planner so nothing falls between the two.

Does choosing hospice mean removing the feeding tube?

No. Hospice does not require any particular decision about a feeding tube. Some families continue it, some stop it, and some never place one. The hospice physician and nurse talk it through honestly, and the choice stays with the family and the patient.

He cannot speak. How will you know what he needs?

Our nurses are trained to read pain, distress and comfort in people who cannot say it: facial expression, breathing, restlessness, how the body responds to touch and turning. We also work with the family to find yes-and-no signals, and we speak to the patient, not over him, in every visit.

What if she gets better?

It happens, especially after the sudden strokes. If your loved one stabilizes and no longer meets hospice criteria, she can be discharged from hospice and return later if needed. Nothing about hospice is a one-way door.

Can we keep her neurologist or primary doctor?

Yes. Her own physician can remain the attending doctor, and our nurses communicate with that office. Keeping your own doctor on hospice.

What does Medicare cover, and what about Medicare Advantage?

For a person with Medicare Part A, hospice after a stroke is covered in full for nearly every family: nursing, aide visits, the hospital bed and mattress, oxygen, comfort medications, supplies, social work, chaplain and bereavement support. Medicare Advantage members are covered the same way through Original Medicare and keep their plan. Does Medicare cover hospice in Michigan? explains it line by line.

We are in Wayne County. How quickly can someone come?

We serve all of Oakland, Macomb and Wayne counties from Troy, and we can usually visit for an evaluation within a day, including evenings and weekends.

Where we come to you

Lily Hospice cares for families at home, in assisted living, memory care and skilled nursing across Oakland County, Macomb County and Wayne County, from our office in Troy. Veterans and their families can read about our veteran-specific hospice care; the heart failure page covers a related condition.

General education, not medical advice. Whether hospice is appropriate is a decision made with your loved one’s physician. Medicare hospice eligibility is based on a physician’s judgment that life expectancy is six months or less if the illness runs its usual course; people are not required to stop living past six months, and care can continue as long as they remain eligible.

Hospice isn’t giving up. It’s showing up. Call (248) 955-5100. A real person answers, 24 hours a day.