When the time comes for hospice, it’s important to find a provider that meets your loved one’s needs and makes the transition from treatment to symptom management and palliative care easier for you and the rest of your immediate family. Hospice services shouldn’t vary from one provider to another, but how the care team delivers these services can make all the difference. When you talk with potential hospice-care providers, the level of knowledge and compassion they show as they answer the following questions will help you make the best choice. Here’s what to ask to help you compare your options…
Are you Medicare-certified? It’s rare for a hospice not to be approved for Medicare patients, but you won’t get coverage under Medicare/Medicaid if it’s not. You might also ask whether they can help you with the Medicare paperwork, which can be daunting. Medicare covers hospice care under Medicare Part A (hospital insurance). Most private insurers have a hospice benefit as well if your loved one isn’t on Medicare.
Are you accredited by an independent organization? While hospices in most states must be licensed on a state level, they are not required to be accredited by any additional quality-assurance organizations. However, getting accreditation is a sign that the hospice cares about meeting quality standards. The Joint Commission, the Accreditation Commission for Health Care and the Community Health Accreditation Program are among the leading nonprofit accrediting organizations. Another positive sign is membership in the National Hospice and Palliative Care Organization, which sets standards for hospice programs. Also ask about the most recent survey by a state or federal oversight agency and whether any recorded problems have been corrected.
Can I have references? Ask for references from families who have used the hospice. When you talk to a reference, ask whether the hospice delivered on its promises and provided the care it said it would in a timely manner, particularly for continuous care for acute symptoms. Medicare requires that hospice offers continuous care at home (for at least eight hours in a 24-hour period) and that at least half of that care be by a nurse—RN, LPN or LVN. In reality, some hospices are better at providing continuous care than others. Continuous care at home may be particularly important to you if your loved one has dementia since moving him from home, even temporarily, may be disorienting. The best judge of a hospice is someone who has had experience with it.
How many patients do you serve at any given time? Some hospices care for large numbers of patients and may have more resources and staff to meet your needs. Those who care for only a small number may offer more personalized care. Ideally, the hospice nurse assigned to your loved one should have no more than 12 patients under his/her care at one time on average.
Do you offer alternative/additional care? Medicare-certified hospices must offer doctor services, nursing care, medical equipment, medical supplies, drugs to control pain, home health aides and emotional and spiritual counseling. Some hospices also offer additional services. Music therapy, for example, often is calming and comforting for patients with dementia…pet therapy can reduce feelings of depression and loneliness and bring joy to your loved one…massage therapy can provide comfort and help your loved one relax. You may want a hospice that can provide these extra services should your loved one ever need them.
How large is your list of volunteers? Hospice companies depend on volunteers to provide a variety of services to their clients such as running errands, doing light household chores and simply staying with the patient while family members run errands. You want to get a sense of whether a hospice has enough volunteers so that one will be available when you need one…and how far in advance you need to request one.
Will you keep your primary doctor informed? While hospice care is meant to provide comfort when a patient is not pursuing treatment, most people who are chronically and then terminally ill have a strong relationship with their primary care provider or specialist, such as their oncologist. If your loved one wants to maintain that relationship, you want a hospice that will collaborate or at least communicate with this doctor. The hospice’s medical director can take over your loved one’s care, but that should be your choice, not the hospice’s.
Which facilities do you contract with for in-patient care? Your loved one might need in-patient care temporarily for such crises as uncontrolled pain, trouble breathing, seizures, nausea, vomiting or diarrhea that doesn’t stop. The hospice should offer in-patient hospice service, perhaps in conjunction with a local facility such as a nursing home or hospital, so that hospice care can be provided around the clock. Ask for the names and locations of these partners and check them out. Make sure they’re acceptable to you and convenient.