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How To Choose A Hospice

In-Depth Research

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If time permits, you or someone acting on your behalf may also want to consider these more detailed issues:

Professional References: The hospice agency should be able to provide several professional references, including hospitals and social workers that have used their services.

  • Obtain the specific names of individuals and their telephone numbers.
  • Call them. What have been their experiences with the agency? Would they recommend the agency over other hospice agencies in your area?' If so, why? If no, why not?

Written Description of Services: The hospice should be able to provide you in writing

  • Information about admission requirements.
    • What geographical area does the organization service?
    • What's involved in the admission process?
    • How long does it take to complete the admission process? (Most hospice programs should be capable of providing care within 24 hours after being contacted.)
  • An outline of the services offered, including those designed to meet your medical, physical, psychological and spiritual needs. A full service hospice provider should be capable of addressing all of these needs. A hospice that can only provide partial services may result in disruptions at a time when you and your family are least equipped to deal with them. For example, an agency that has no provisions for inpatient hospice treatment, should the need arise, could result in a standard hospital admission. In such case, you would probably be in a standard hospital room and be subject to all the rules and regulations of the admitting hospital instead of a comfortable home-like setting with relaxed rules. As another example, even the lack of minor services can have a large impact on caregivers. For example, a partial service agency may not have the necessary volunteer support staff to provide occasional services such as babysitting, running errands, or spending a few hours with the patient while a family caregiver attends to other duties.
  • Cost of care and payment options, including billing methods.
  • Employee qualifications and their specific job descriptions. Does the hospice/employer require and verify employee references? Do the employees receive special training related to caring for hospice patients?
  • Confirmation/ proof of malpractice and liability insurance.

Initial Patient Evaluation: The following are important considerations in the patient evaluation process.

  • Does an experienced registered nurse or social worker, rather than an agency clerk, provides the evaluation?
  • Are your primary care doctor and other health care team members (such as your social worker) consulted regarding your needs? Those professionals who have treated you are likely to have the greatest insight into your needs and requirements.
  • Is your family, or those who will be providing day-to-day care, consulted?
  • Who determines what personal services you can provide for yourself, such as bathing and grooming? If you and / or your family caregivers are not directly consulted, it may be assumed that you are capable of performing certain tasks for which you may actually require assistance.
  • When determining your needs, is the evaluation conducted in your home, rather than on the telephone? Viewing your physical living space may provide the evaluator with a better sense of your personal home needs. For example, will you require the services of a home health aid to safely get in and out of the shower or bathtub? Will a standard size hospital bed, walker, or other durable medical equipment, fit / function properly in your home? Are there other changes the evaluator might suggest to make functioning in your home safer or more comfortable?
  • If you and / or your doctor are not certain that you meet the qualifications (such as life expectancy requirements), ask if the hospice personnel can assist with the determination?

Plan of Care: The hospice should provide an initial plan of care that will be revised and updated as needed. Everyone involved in your care should receive a written copy.

  • The agency should create a personalized plan of care that is designed to meet your individual needs and requirements, as determined by you, your family caregivers, and the hospice organization.
  • It is advisable to have your primary care doctor involved in planning and over-seeing your plan of care.
  • The plan should include special consideration for pain management. To learn more see Managing Pain.
  • The plan of care should include a list of specific medical and social services to be performed by the hospice staff, including the days and work hours in which they are to be provided.
  • The plan should include the name and telephone number of the supervisor in charge of your care.

Inpatient Care: There are times when inpatient care in a hospital, nursing home or hospice facility may be necessary, whether to provide additional pain management or to provide a respite for your family caregivers. It is important to confirm that the organization provides inpatient services.

  • What is the hospice policy regarding inpatient and respite care?
  • Where is the inpatient care provided, and by whom? These services are typically provided in hospitals, skilled nursing facilities, or private inpatient hospice facilities.
  • How long can inpatient hospice care continue?
  • What hospitals contract with the hospice for inpatient care?
  • If the care is to be provided in a skilled nursing facility, will you receive the same level of nursing care, pain management, counseling and other social work services, as is provided in the home care setting?
  • Consider touring, or asking someone to tour for you, the hospice inpatient facility. Even if you plan to receive your care at home, a visit will provide you with an opportunity to see the hospice agency and its treatment philosophy in action. You may even wish to meet and speak with families at the facility. What experiences have they had with the agency?

Costs: Costs, including out of pocket expenses, can vary widely depending on your needs. Obtain all financial arrangements in writing and review them thoroughly before signing. Be certain to keep a copy.

  • What are the costs?
  • Are you required to use the services for a minimum number of hours per day or per week?
  • How much of the cost will be covered by your insurance?
  • Who is responsible for billing services for Medicare or other insurance coverage?
  • What expenses / services will you have to be pay out-of-pocket?
  • Does the hospice organization provide payment plan options?
  • If you require financial assistance, what sort of resources can the organization provide?
  • Will the hospice provide care if you have no medical insurance coverage, and limited or no financial resources? What services will be provided?

Additional Considerations

  • If you require specialized medical equipment / supplies (such as oxygen or a wheel chair) in the home setting, can the agency make arrangements for delivery and maintenance? Can they provide training for use by family caregivers?
  • If you make the decision to change hospice agencies, are you allowed to retain any durable medical equipment you may currently be using (such as a hospital bed or wheel chair)? Hospice organizations often contract with medical equipment suppliers and may insist on providing their own equipment. However, obtaining new equipment can be disruptive to your life. Confirm with a new hospice agency that you will be allowed to continue with any durable medical equipment you may already have. We know of an individual who was able to make these arrangements by appealing directly to the hospice administrator.
  • What plan does the agency have for emergencies? Will they still be capable of providing services in the event of a power outage or natural disaster? This can be especially important if you are using medical equipment that requires electrical power.
  • What is the process for filing and resolving complaints?
  • Will the hospice honor your decisions about end-of-life as described in your Living Will and other advance directives? This is generally not a problem as hospice care is designed to neither shorten nor prolong life. However, you may wish to check their policy regarding issues such as hydration, feeding, and use of antibiotics.
  • If the hospice is unable to provide full service care, what type of arrangements can the agency make to obtain additional home services? What sort of arrangements does the agency make for those individuals who require periods of inpatient care?
  • Confirm that the hospice provides a 24-hour telephone number for questions, counseling, and crisis periods.

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