24/7 nurse coverage for hospice, without the on-call burnout.
Every Medicare-certified hospice has to make nursing services routinely available around the clock. Most meet it by rotating field nurses through a pager. That works until it costs you the nurse.
Nurse availability isn't optional. It's a Condition of Participation.
Every Medicare-certified hospice must make nursing services “routinely available on a 24-hour basis, 7 days a week.” A surveyor can, and does, ask a hospice to demonstrate that a licensed nurse was reachable for any hour of any day in the survey window, including the 2 a.m. call from a family member watching a patient's breathing change.
Nursing services, physician services, and drugs and biologicals must be “routinely available on a 24-hour basis, 7 days a week.”
Most hospices meet this today by rotating field nurses through an on-call pager. It works, until it doesn't: the nurse on call at midnight is the same nurse carrying a full patient load at 8 a.m., and every additional night on the pager is a data point in why hospice RNs burn out and leave.
Nurse turnover costs the industry real money. The 2025 NSI National Health Care Retention & RN Staffing Report put the average cost of turnover for a single staff RN at $61,110, a figure the 2026 edition revised only slightly, to $60,090. Against that, the arithmetic on after-hours coverage stops being about the monthly fee. The full calculation is here.
The pager stops. The coverage doesn't.
TULQ takes the after-hours call so your field nurses can actually sleep between shifts, and hands you a documentation trail a surveyor can review.
Licensed RNs, every hour
Every call is triaged by a U.S. state-licensed registered nurse, never a call-center rep reading a script, never AI making the clinical call.
Schmitt-Thompson, not improvised
The same validated protocol framework used across the telephone triage industry, so every triage decision is defensible and repeatable.
Documentation, survey-ready
Every encounter is documented and delivered in a format your agency can hand a surveyor as proof of 24-hour nurse availability.
The home health side answers to a different set of levers: OASIS, HHVBP, and acute-care utilization rather than a Condition of Participation. Nurse triage for home health is covered here. Same line, same nurses.
Where to go next
The true cost of after-hours on-call
The four line items agencies never total in the same place, with a worked example.
Read →After-hours access and hospice CAHPS
Which measures it moves, which it doesn't, and the proxies to track meanwhile.
Read →Nurse triage vs answering service
The distinction that justifies the price difference, in one table.
Read →Comparing triage vendors
IntellaTriage, Conduit, AccessNurse: what each is built for, and when to pick them.
Read →What hospice administrators ask us first
Does Medicare require 24/7 nurse availability for hospice?
Yes. 42 CFR § 418.100(c) requires nursing services to be routinely available on a 24-hour basis, 7 days a week, for every Medicare-certified hospice.
Can a hospice outsource its after-hours on-call nurse coverage?
Yes. Hospices routinely contract with an outside nurse triage service to satisfy the requirement, provided the service uses licensed RNs, follows a validated clinical protocol, and produces documentation the hospice can keep on file.
What happens on a death call?
It goes to your clinician, every time. Pronouncement, family support at the bedside, and the coordination that follows are your team's work, not a triage line's. What TULQ does is take that call immediately, gather what your clinician needs, and reach them without the family sitting in a queue.
How does this affect our CAHPS scores?
Several CAHPS Hospice measures turn on nights and weekends: whether the family got help as soon as they needed it, and how the team communicated. We go through which measures after-hours access actually moves, and which it doesn't.
What else we run for you
Hospices come to us for the Condition of Participation. Agencies that also run a home health or palliative line usually find the same nurses can carry the post-discharge and chronic-care work their staff absorbs unpaid.
CCM, APCM, PCM and TCM
Medicare pays every month for managing chronic patients between visits. Our nurses do the work inside your record and log the time that makes it billable.
Read →Medicare annual wellness visits
Compact-licensed RNs complete the visit by telephone and hand back finished documentation. Priced per completed visit.
Read →How the three fit together
The wellness visit enrolls, care management retains, and the after-hours line covers the night. Same nurses across all three.
Read →Sources
- 42 CFR § 418.100(c), Medicare hospice Conditions of Participation.
- NSI Nursing Solutions, National Health Care Retention & RN Staffing Report.
- CMS, CAHPS Hospice Survey materials.
- Schmitt-Thompson telephone triage protocols.
Conditions of Participation and published survey figures change. Verify against the current CFR and CMS guidance before relying on them. TULQ is launching in 2026; this page describes the service model, not past contract performance.
See the line before you commit to it.
Request a capability statement or start a pilot alongside your current on-call rotation. We would rather you saw how it runs than took our word for it.