Orientation on file for every new hospice hire
Federal hospice rules call for two orientations: the hospice philosophy for anyone with patient and family contact, and job-specific duties for each employee. Personnel Ledger puts both on a new hire's file from the first day and shows what is still open.
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Built from the federal hospice orientation rules, CMS survey reports and our state research. General information, not legal advice. Confirm your specifics with your state and your accreditor.
Two orientations, and who each one reaches
Orientation about the hospice philosophy for all employees and contracted staff who have patient and family contact.
42 CFR §418.100(g)(1)An initial orientation for each employee that addresses that employee's specific job duties, office roles included.
42 CFR §418.100(g)(2)Job-specific orientation is written for "each employee," so it does not reach contracted staff. Philosophy orientation does, when they have patient and family contact.
42 CFR §418.100(g)(1)-(2)Federal rules count a volunteer under the hospice's jurisdiction as an employee (42 CFR §418.3), so volunteers need orientation too. Their files usually live with the volunteer program, which Volunteer Ledger tracks.
Orientation done, but not in the file
By our count of CMS survey reports, 41 of the 2,031 hospice standard surveys in 2025 that found any deficiency cited job-specific orientation (L0662), and 39 cited hospice philosophy orientation (L0661).
Source: our count of CMS QCOR hospice survey reports (Form CMS-2567), CY2025 standard surveys with at least one finding, state agencies and accreditors combined.
Philosophy orientation missing
One 2025 accreditor survey found 9 of 12 files, employees and contract employees alike, with no evidence of hospice philosophy orientation.
A role skipped
A chaplain's file had no job-specific orientation, a reminder that the rule reaches every employee, not only nurses and aides.
Volunteers not oriented
Volunteer files with no orientation on record were cited too, because the rule counts volunteers as employees.
Orientation is not the only first-week item
Three more federal items usually land in a new hire's first weeks. Personnel Ledger tracks them on the same file.
Emergency preparedness training
Initial training for employees and anyone providing services under arrangement, then at least every two years.
42 CFR §418.113(d)(1)Infection control education
Education for employees and contracted providers. The rule sets no interval, so your policy does.
42 CFR §418.60(c)Criminal background check
Timing follows state law. Where the state sets none, within three months of the hire date.
42 CFR §418.114(d)Some states add orientation rules of their own. Three examples from our state research:
| State | What it adds | Rule |
|---|---|---|
| Georgia | Orientation that covers hospice concepts, patient rights including abuse reporting, disaster preparedness, fire safety and evacuation. | Ga. r. 111-8-37-.13 |
| Arizona | Orientation within the first week of employment. | A.A.C. R9-10-606 |
| California | Management staff: 20 hours of orientation within 60 days, then 12 hours a year. | 22 CCR §74880 |
More state rules are in hospice staff requirements by state.
On the new hire's file from the first day
Both orientations, by role
Hospice philosophy orientation applies to the roles with patient and family contact; job-specific orientation applies to every employee role.
Due from the hire date
Each one comes due the number of days after hire your policy sets, so a new hire shows what is open on day one.
Contractors handled plainly
A contracted therapist carries the philosophy orientation. Job-specific orientation can be marked not required for them, with the reason, so it never reads as missing.
The sign-off beside the date
Record the date and who gave the orientation, and attach the signed checklist or acknowledgment.
Kept after they leave
Deactivating a person keeps their file and its history intact.
Questions about orientation
What is the difference between hospice philosophy and job-specific orientation?
Philosophy orientation introduces the hospice philosophy of care (42 CFR §418.100(g)(1)). Job-specific orientation covers the duties of the person's own job (42 CFR §418.100(g)(2)). Many people need both.
Do contracted hospice staff need orientation?
Contracted staff with patient and family contact need orientation to the hospice philosophy. Job-specific orientation is written for each employee, so the federal rule does not extend it to contractors, though your own policy may.
Do office and billing staff need hospice orientation?
They need job-specific orientation, because the rule covers each employee. Hospice philosophy orientation applies only if their work brings patient and family contact.
How soon after hire must hospice orientation happen?
The federal rule calls for an initial orientation without naming a number of days. Some states set one: Arizona expects orientation within the first week, and California gives management staff 60 days to complete 20 hours. Write your timeline into policy and track against it.
Do hospice volunteers need orientation?
Yes. A volunteer under the hospice's jurisdiction counts as an employee in the federal rules (42 CFR §418.3), and volunteers have their own training rule as well. Volunteer Ledger keeps volunteer files.
What should an orientation record show?
The date, which orientation it was, who gave it, and the person's signed acknowledgment or checklist. The 2025 findings read "no evidence" when that record was missing, even where the orientation itself may have happened.
This page is general information, not legal advice. Orientation requirements come from federal regulation, your state's law and your accreditor, and they change. Confirm your specific obligations with your state licensing authority and your accreditor.
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