So, how do you find the most hospice that is right for you and your family?
You gather information about them in a number of ways, just as you do with other healthcare professionals you use -- physicians, dentists, hospitals, nursing facilities, etc. You ask people for recommendations, you read about them online, you call their offices and ask questions, and/or you pay them a visit.
We have pulled together a list of topics and questions for you to ask as you explore the hospice options where you live. What you learn will guide you as you make an informed decision when choosing hospice care.
Recommendations & References
Ask people with whom you are connected if they have had experience with certain hospices. Word-of-mouth references from people you trust (healthcare providers, friends, family, co-workers) can be helpful in forming an overall impression of a hospice agency.
Ask the hospice to give you references from professionals such as a hospitals, physicians, and social workers who have used their agency.
Location & Years of Service
Ask how long the agency has been doing hospice care. Years of service is an indication of stability, and sometimes the hospice is an add-on to a company that has been around longer, providing other kinds of healthcare goods and services. As a point of reference, the first hospice opened in the United States in 1974, and many hospices began operation in the 1980s. Hospices have opened continually since then and are still being opened every year.
Medicare Certification, State Licensure, and Accreditation
The hospice should be licensed in the state in which it is operating if the state requires it.
Accreditation by an independent healthcare accrediting group (such as JCAHO, CHAP, or ACHC) is not required and, without it, a hospice can still provide stellar service. What it means, however, is that a third party has reviewed the hospice’s operations and determined it meets a certain standard of care.
Medical Professionals & Volunteers on Staff
• A Medical Director who is either full-time, or who is—or has staff who is—available during evenings and weekends.
Ask if the physicians are hospice or palliative care certified. It represents a level of expertise that reflects well on a hospice.
• Nurses – Ask if a nurse is assigned to each patient as their case manager? It is preferable to have a RN (registerd nurse) managing the hospice team’s care of the patient and family.
Ask how many staff nurses have earned certification in their hospice and palliative care field (CHPN is the designation you’re looking for). It shows that these professionals have taken the time and effort to become specialized in their field, and a hospice agency that has several of these is likely focused on quality.
• Nursing Assistants, or Health Aides, sometimes referred to as CNAs (Certified Nursing Assistants) – These trained professionals help with a variety of toiletry and housekeeping needs, and this varies quite a bit. Find out what they do, if they can be scheduled, and if they are on-call for weekend visits.
• Social Workers and Chaplains – The hospice should employ them fulltime, as you will want access to them to some degree at some point.
• Bereavement counselor – The hospice should employ counselors who are available to patients and families both before and after the death of a loved one.
• Volunteers – One mark of a really good hospice is a large number of volunteers who are well-trained to do a variety of patient- and family-related services. This might not be important to you in the beginning, but it could be at some future point.
On-call Nursing Staff
Ask: How do you respond to phone call during the day, and at night and on weekends?
Ask: How soon after we decide to receive care can an admission to your hospice be done? Who will do the admission?
Levels of Hospice Care
• Routine Home Care is the basic level of care and is used for the majority of hospice patients. If applicable to you, ask if hospice care can be provided in a skilled nursing or assisted living facility and, if so, which area facilities the hospice serves.
• Continuous Care (or Crisis Care) is for patients having symptoms that cannot be controlled via routine care. Hospice staff stays at the bedside for a minimum of 8 and up to 24 hours a day to provide symptom management.
• Respite Care is designed to give caregivers a break if they are burnt out or otherwise need a temporary break. Ask who the hospice agency has a contract with. (Nursing facilities, hospitals, and hospice inpatient units—also referred to as an IPU or a Hospice House—all provide this service.)
• Inpatient Hospice Care patients are admitted to a hospice house, nursing facility or hospital for a short time where they can receive ‘round-the-clock care from medical staff until symptoms are under control. Ask who the hospice agency has a contract with.
You should ask your hospice agency which of these levels they can perform, and where they take place. Ideally, a hospice agency should have a contract with a hospice house, nursing facility or hospital to provide inpatient care and respite care in the event a patient needs it.
Hospice Inpatient Unit
Ask if the hospice has their own inpatient unit or hospice house and what levels of care are provided there?
Individualized Care Plan
Cost of Hospice Care
Ask: Which pharmacies do you work with?