Questions to Ask When Selecting a Hospice Agency

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Questions to Ask When Selecting a Hospice Agency

Postby Robin » Wed Jun 25, 2014 5:38 pm

A short interview with the head of the American Hospice Foundation was in last Tuesday's New York Times. She believes: "You have to become a very savvy consumer about what is likely to be the most important
health care decision you make in your life." To that end, she offers some questions that she'd recommend people ask each hospice agency being interviewed:

* How long have you been in operation?

* What can you tell me about your staff's response time should I need your services on the weekend or on evenings? How long will I have to wait in an urgent situation?

* Is it your practice to keep a nurse or another clinician in the home when a patient is actively dying? Does the family get support? Do you see the patient through death?

[Robin's note: Not all families want "continuous care," but I agree with the premise that it should be available to those families who want it.]

* Do you have an inpatient facility, in case my symptoms become complicated?

* What kind of respite care do you offer, under what circumstances? Would it be a nurse or aide who comes, or a volunteer? Do you provide it once a week or twice? For how long?

Note that the American Hospice Foundation ( is closing its doors at the end of June 2014 so check out their website now to gather useful info. Beneath the link to the short New York Times article, I've copied the American Hospice Foundation's list of 16 questions to ask when selecting a hospice agency.

A final note: Lots of people don't know that you can change hospice agencies. If the agency you initially selected doesn't work out, consider changing to a different agency. Asking at a local support group meeting is a good place to get the low-down on hospice agencies in a particular geographic area. If you can't attend a support group meeting, ask friends and neighbors, or ask at a senior center or place of worship near you.


How to Choose a Hospice
By Paula Span
The New Old Age: Caring and Coping
The New York Times, June 17, 2014 1:43 pm

Choosing a Hospice: 16 Questions to Ask
American Hospice Foundation

Hospice is a set of services that we all may need someday - if not for ourselves, for our parents. While death is not an option for any of us, we do have choices about the services we use at the end of life. Hospice is undoubtedly the best option in the last months of life because it offers a whole variety of benefits, not only to those of us who are dying, but also to those we leave behind.

How do you find the most appropriate hospice? Until hospice quality data is readily and easily available to all of us, the experts at American Hospice Foundation have pulled together some tips for choosing the most appropriate hospice. Answers to these questions will give you clues about quality of care and help you make an informed assessment.

* What do others say about this hospice? Get references both from people you know and from people in the field -- e.g., local hospitals, nursing homes, clinicians. Ask anyone that you have connections to if they have had experience with the hospice and what their impressions are. Geriatric care managers can be a particularly good resource, as they often make referrals to hospices and hear from families about the
care that was provided. Anecdote and word of mouth won't paint a full picture but they are still valuable data points.

* How long has the hospice been in operation? If it has been around for a while, that's an indication of stability.

* Is the hospice Medicare-certified? Medicare certification is essential if the patient is a Medicare beneficiary to permit reimbursement.

* Is the hospice accredited, and if required, state-licensed? Accreditation (JCAHO or CHAP) is not required and not having it doesn't mean a hospice isn't good, but if the hospice has it, then you know a third party has looked at the hospice's operations and determined they come up to a reasonable standard of care.

* What is the expectation about the family's role in caregiving? See if what the hospice expects from family members is consistent with what the family is able to do.

* Are there limits on treatment currently being received? Is there anything currently being done for the patient that a hospice under consideration would not be able to do?

* Can the hospice meet your specific needs? Mention any concerns the family or patient have about care and ask the hospice staff how they will address those concerns.

* Does the hospice offer extra services beyond those required? Some services fall in a gray area. They are not required by Medicare but may be helpful to improve the comfort of a patient. An example is radiation and/or chemotherapy for a cancer patient to reduce the size of a tumor and ameliorate pain. Some hospices would not be able to afford to do this but others with deeper pockets could.

* How rapid is crisis response? If the family needs someone to come to the home at 3AM on a Saturday, where would that person come from? What is their average response time?

* What are the options for inpatient care? Patients being cared for at home may need to go to an inpatient unit for management of complicated symptoms or to give their family respite. Facilities can vary from the
hospice having its own private inpatient unit to leased beds in a hospital or nursing home. Visit the facilities to ensure that they are conveniently located and that you are comfortable with what they offer.

* If the family caregiver gets really exhausted can we get respite care? Caring for someone with a serious illness can be exhausting and, at times, challenging. In addition to home hospice care and inpatient care when symptoms prove unmanageable at home, hospices also offer "respite" care (periodic breaks for the caregiver of up to 5 days during which the patient is moved to an inpatient bed) and "continuous" nursing care at home for brief periods at the patient's home when family caregivers are unable to manage on their own. Ask the hospice under what conditions the hospice provides these types of care.

* Are their MDs/RNs certified in palliative care? Not having it doesn't mean the staff is not competent as experience counts for a lot but having this credential is an indication of specialized study in palliative medicine/nursing.

* How are patient/family concerns handled? Is there a clear process for sharing concerns with appropriate hospice staff and making sure they are addressed, including a process for escalation if the concern
is not adequately addressed at lower levels?

* How does the hospice measure and track quality? You are not looking for a lot of technical detail, just a response that indicates that the hospice evaluates its own performance in order to improve it.

* What are your general impressions at initial contact? What is your reaction to the people you talk to?

* What kind of bereavement services does the hospice offer? Types of grief support can vary widely and may include individual counseling, support groups, educational materials and outreach letters.

The authors, Naomi Naierman and Marsha Nelson, are the president and vice president, respectively, of the American Hospice Foundation. AHF closed its doors in June 2014 after nearly 20 years of improving access to quality hospice care through public education, professional training, and advocacy on behalf of consumers. AHF leaves a legacy of educating the public about hospice and heightening awareness of grief issues in the schools and workplace. AHF has contributed to the continuation of its important work with two legacy projects ­funding Altarum Institute's Center for Consumer Choice to develop a web-based tool that enables users to select the most appropriate hospice for their situation, and an initiative by the Tragedy Assistance Program for Survivors (TAPS) to assist grieving children of veterans.
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Re: Questions to Ask When Selecting a Hospice Agency

Postby gulfcoastpsp » Fri Jul 04, 2014 3:10 am

Heart To Heart Hospice are our champions in the Texas Gulf Coast region.... Our approach during the qualification process was difficult and arduous but they passed the litmus test. Families should always negotiate directly with the Executive Director during the admissions process. In our experience ask for Karen Merchant and invite her to you home....
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