Compiled from the Mail Bag:  My father, age 83, has a long history of heart disease, Parkinson's, and macular degeneration. He is now almost blind. He now faces kidney failure, and his doctors are talking about having to put him on dialysis soon. My father doesn't want to do that. I believe him when he says he is ready to go. His doctor doesn't want to talk about Hospice, but my father does. I believe that he is able to make his own decisions about this, and I support him with whatever decision he makes. How can I enroll him in Hospice?

A: Your father's doctor may not believe that your father is terminally ill because he has the option of dialysis to prolong his life. However, if your father decides not to pursue this treatment his life expectancy will inevitably be short. This is the case with many chronic illness when the patient decides that aggressive treatment is no longer desired.

Most patients are referred for hospice care by their physicians. In that case there is nothing for you or the patient to do but decide which hospice provider to use. Many patients choose to enroll with the hospice provider their doctor recommends, in which case the doctor or his nurse makes the call and a hospice representative will come to the patient to start the process.

If the doctor is not ready or not willing to make a referral, the patient or caregiver always has the right to elect hospice care. You can initiate the process by calling your chosen agency and "self referring." The hospice medical director or another physician will then evaluate whether the patient meets the eligibility guidelines. If the answer is "Yes," then that doctor will "certify" the patient to receive hospice benefits.

If your doctor is not making the referral, then your first step is to choose a hospice provider. If you know someone who was pleased with their experience, then that is a good referral. You can also speak with your present home care agency if you have one. They generally know and have worked with several agencies.

As a last resort, The National Hospice and Palliative Care Organization can help you find member agencies.

Once you have selected your provider, a simple telephone call to the agency is all you need to start the process. A hospice nurse will then visit you and the patient to talk with you about their services and the enrollment process. If you decide to move ahead, the hospice gency will do the rest for you.