How to Choose a Hospice Provider

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When you or a loved one are referred to hospice for end-of-life care, either by a physician or hospital case worker, you’ll usually be given a list of hospice agencies in the area to choose from. But navigating that list—and knowing what to ask—can be overwhelming. Here, eight questions to get you started when choosing a hospice provider.

1. Are you Medicare certified?

This is essential if you are a Medicare beneficiary, since it ensures that Medicare will cover costs for either inpatient or at-home hospice. If the provider is Medicare certified, it’s also legally required to confirm to certain Medicare rules and regulations, including reporting the quality of their patient care. The official government Medicare site offers an online comparison tool that allows you to see how different hospices in your area compare to the national average when it comes to measures like managing pain and taking into account a patient’s beliefs and values when providing care.

2. Are you accredited?

Look for a hospice that has national accreditation from an organization such as the Accreditation Commission for Health Care, the Community Health Accreditation Program, or the Joint Commission on Accreditation of Healthcare Organizations. They also should be a member of the National Hospice and Palliative Care Organization and have completed the Standards Self-Assessment within the last couple years.

3. Can you refer me to other families?

Most hospices will allow you to speak to several other families who have used their services. Many also ask family members to complete a survey after a patient’s death, so you can request their most recent scores to see how they’re rated.

Word of mouth is important, too: Get references both from people you know and from local hospitals, your physicians, or your geriatric nurse or case manager, says Nicole Christensen, director of Care Answered, a Long Island, New York health care advocacy group. All these people may be able to paint a fuller picture than you’d get from just calling a hospice or reading a brochure.

4. Do you offer an inpatient option?

Even if you choose to have hospice care provided at home (as most people do), it’s good to know you have options if the patient suddenly develops a serious complication or the caregivers simply become overwhelmed. Some hospices have their own private inpatient unit, while others lease rooms in a hospital or nursing home. Experts say the best place to receive inpatient hospice care is in a dedicated hospice unit or freestanding facility, rather than so-called “scatter beds” at a hospital or skilled nursing facility.

Also ask if the hospice offers respite care, so that if family caregivers need a break—whether it’s for a few hours or a few days—there is reliable and responsible nursing care available.

5. Are your doctors and nurses trained in palliative care?

These medical professionals differ from regular physicians and nurses because they are specifically focused on improving your quality of life, not curing you of your disease. Ideally, the physicians on staff should have done a fellowship in hospice and palliative medicine. They have training in pain management and symptom control, and work with patients and their families to prepare them for death and dying.

For physicians, look for subspecialty board certification in hospice and palliative medicine, and/or Hospice Medical Director Certification. Nurses should ideally be certified by the End-of-Life Nursing Education Consortium (ELNEC) and/or be a Certified Hospice and Palliative Nurse (CHPN), which is provided by the Hospice & Palliative Nurses Association.

 

6. How accessible is your medical team?

If you’ve opted for at-home hospice, you should make sure that you can reach someone on the hospice staff 24/7 and that they can send a nurse or social worker out to your home anytime there’s a crisis (including at 3 a.m.). It’s also a good idea to check the staff to patient ratio, adds Annie Luchsinger, co-founder and COO of the online hospice review site Grace.

Nationally, the average number of home visit patients per hospice nurse or case manager is about 12. With significantly more patients than that, your nurse or case manager may not be accessible when you need them.

Ask about what other team members may visit, too. Some hospices offer volunteers who can run errands or provide respite care in a pinch.

7. What “extra” services do you provide?

There is a huge variation in the kinds of additional services hospices may provide. Some hospices offer programs geared specifically to children or people with specific diseases, “pre-hospice” care for those who aren’t yet emotionally or physically ready to enter full hospice care, and pick-me-ups such as therapy pet visits and massage, says Christensen. Some even provide resources for patients that do not have any hospice coverage or insurance or who can’t afford burial costs. 

8. Can I still see my primary care physician or specialist?

The answer should be yes, and in fact you’ll be encouraged to do so in many cases. Your other doctor(s) can collaborate with the hospice team to provide care that focuses on your needs and preferences.

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