When a terminally ill patient chooses to spend their final days at home, an unexpected fever or a night of struggling to breathe can plunge family members into panic and helplessness. Beginning in 2024, Taiwan officially extended the Home-Based Emergency Care system to include patients receiving home palliative care, filling the gap between regular home visits and sudden emergencies. From policy trials to community practice, this initiative is helping uphold the dignity of end-of-life choices and making dying peacefully at home no longer just a wish.
At 2 a.m., an elderly woman under home hospice care developed a persistent high fever and severe shortness of breath. Her desperate family, voice trembling, called the emergency department: "We don't want to send her to the hospital… but what should we do now?" This phone call was not only a request for medical assistance but also the family's final effort to honor their loved one's wish—to complete her journey at home, surrounded by love.
In recent years, more families have chosen home-based end-of-life care. However, even when a hospice patient’s condition seems stable, sudden crises such as infections, electrolyte imbalance, or breathing difficulties may arise. When patients can only rely on weekly hospice visits, but emergencies strike at midnight, families are forced into difficult decisions. These abrupt hospital transfers cause not only physical suffering but also disrupt the trust and continuity built between patients, caregivers, and medical teams.
Why Hospice Patients Need Home-Based Emergency Care
"Home hospice care doesn't mean someone visits every day—but when emergencies arise, they can't wait," said Chung-Liang Shih, Director-General of the National Health Insurance Administration, Ministry of Health and Welfare, explaining the motivation behind this system.
According to Ministry statistics, about 200,000 people in Taiwan currently receive home medical care, long-term care, or live in institutions. Each year, around 70,000 of them are hospitalized due to emergencies, 80% of which are caused by infections. In other words, even when patients have chosen to die at home, pneumonia, urinary tract infections, or other acute conditions often force them into hospitals—against their original wishes.
To address this care gap, the National Health Insurance Administration launched the Home-Based Emergency Care pilot in July 2024, initially focusing on infectious diseases. Medical teams visit patients at home to provide prompt assessment and treatment. If fully implemented, the plan could reduce the burden on hospitals by roughly 4,000 beds each year, decreasing unnecessary admissions and easing ward pressures.
In 2025, the program was further expanded to include hospice patients. In reality, when terminal patients develop sudden complications, families often do not know what to do. Weekly visits are not enough during a crisis. Home-based emergency care becomes the key support that allows patients to remain at home.
"We want to give patients a real choice—to stay where they feel safe and walk their final journey steadily," said Shih. "It's not about moving the ER into the living room, but about ensuring patients have the right to choose and are cared for in familiar places, by familiar hands."
Facing Emergencies in the Familiar Space of Home
"She doesn't want to go back to the hospital."
Dr. Ying-Chao Chen, Director of Wei Yang Clinic in Luodong, has heard this countless times. For years, he has been dedicated to home medical care, including caring for patients in home hospice. These families are usually prepared—not for recovery, but for their loved ones to finish life's last mile in familiar surroundings and rhythms. Nevertheless, reality is harsh: even stable terminal patients may suddenly face infections, electrolyte imbalance, or acute breathing problems. "When an emergency strikes, everyone panics—it's unavoidable," he said.
He recalls one patient who suddenly developed a high fever and was gasping for breath, unable to speak. The daughter called, crying: "Dr. Chen, I don't know what to do." Fortunately, the team arrived quickly, provided oxygen, fever-reducing medicine, and antibiotics, and stayed with the family through the night.
Some may ask: "If the patient is already terminal, is it necessary to treat these symptoms?" Dr. Chen's answer is clear—it's not about prolonging life, but about reducing suffering. High fever, dehydration, and suffocation bring unbearable agony not caused by the disease progression itself. "The goal isn't to extend life, but to make these last days less painful."
"If you delay treatment until the ER, hospitalization is likely—and the patient may die in an unfamiliar room," he added. But with timely care at home, the next day the patients can still lie in their own bed, speak with family, even eat a little porridge—finishing their life journey with dignity and comfort. This, he believes, is the essence of hospice care. Emergencies are not exceptions in medicine—they are part of life. Hospice care must prepare not only for calm days but also for moments of crisis.
Care Is Not About Counting Visits, but About Being Present
Frontline experience shows that the teams most capable of handling emergencies for terminal patients are often the hospice teams that know them best. Yet this exposes another issue: Can the system keep up?
"If a patient needs us three times in a three-day period, under the current system we are exceeding the National Healthcare Insurance (NHI) quota, and as a result, points are deducted," Dr. Chen said calmly, though the frustration was evident. The current model reimburses home hospice on a per-visit basis, which may work when conditions are stable, but for patients with fluctuating needs and frequent crises, it becomes restrictive.
"Sometimes we just check blood oxygen, talk with the family, or simply reassure the patient that someone is coming to see him. These moments don't fit neatly into NHI claim forms," Dr. Chen explained. End-of-life care is not linear; what truly matters is not always prescribing medicine or giving injections, but simply presence so that patients and families know they are not facing the end alone.
Chung-Liang Shih acknowledged that the home hospice payment system needs reform. He suggested moving toward a monthly capitation model—payment per patient, not per visit. This way, medical teams receive a fixed monthly amount based on responsibility for a patient’s care, and can adjust visit frequency as needed—whether intensive or minimal. As long as the patient feels secure and the family feels reassured, that should be the right arrangement.
Beyond Medicine: Community Networks Matter
Dying at home is not just a medical issue—it is a life issue.
At home, there may be no doctors or nurses nearby, no monitoring equipment, and sometimes not even access to needed medications. Even with hospice teams in place, without community support, emergency responses often stumble over questions like "Who can come first?" "Where are the medical records?" "How do we get the medicine?"
Shih revealed that the NHI is building a Home-Based Medical Care Information Platform to integrate medical, caregiving, and long-term care records. In the future, if different providers can access a patient's medication history, clinical updates, and contact points, redundant procedures and information gaps can be avoided. For example, if a patient is flagged as high-risk by the hospice team, local clinics or home nursing stations can immediately step in during emergencies without repeating the same assessments.
Technology will also play a role. Tools like real-time blood pressure monitoring, telemedicine, simple blood tests, and infusion devices allow medical teams to see without being there. Each night a patient spends at home instead of being rushed to the hospital means less risk and more peace.
But ultimately, it still comes down to people.
"We often talk about 'bringing healthcare to the rural areas,' but in fact, it's about mobilizing the community itself," Dr. Chen said. At Wei Yang Clinic, he has built close working relationships with local pharmacies, home nursing stations, and nearby clinics. Each knows their role—who can deliver medicine quickly, who can draw blood, who can check a patient's breathing. They operate separately, yet function like one team. That is what a resilient local care system looks like.
Allowing people to die at home is not just a policy—it is a web. This web is strong enough to meet needs, connect people, and hold the final tenderness. This is not a future ideal, but a responsibility to uphold for today. The system is still evolving, but the direction is clear: more people should be able to end life in familiar places, surrounded by love—not alone in a hospital room.
We can make that final path just a little steadier.