There are a number of questions to ask before deciding on a hospice program.
Certification: Is this hospice program Medicare certified? Medicare certified programs have met federal minimum requirements for patient care and management.
Licenser Is the program licensed by the state, if required by your state?
Does the agency have written statements outlining services, eligibility criteria, costs, and payment procedures, employee job descriptions, malpractice, and liability insurance? Is the agency in-state or out-state owned and operated? Is it for profit or a non-profit? Who makes up the agency’s Board of Directors? Are funds raised by the hospice used within this state?
How many years has the agency been serving the community? Can the agency provide references from professionals, such as a hospital or community social workers, who have used this agency? Ask for specific names and telephone numbers. A good agency will provide this on request. Talk with these people about their experiences. Also check with the Better Business Bureau, local Consumer Bureau, or the State Attorney General’s office.
How flexible is this hospice in applying its policies to each patient or negotiating over differences? If the hospice imposes upfront conditions that do not feel comfortable, that may be a sign that it is not a good fit. Also, if you are not certain whether you or your loved one qualifies for hospice, or whether you even want it, is the agency willing to make an assessment to help clarify these issues?
Plan of care: Does the agency create a plan of care for each new patient? Is the plan carefully and professionally developed with you and your family? Is the plan of care written out and copies given to all involved? Check to see if it lists specific duties, work hours/days, and the name and telephone number of the supervisor in charge. Is the care plan updated as the patient’s needs change? Ask if you can review a sample care plan.
Does the hospice require a designated family primary caregiver as a condition of admission? How much responsibility is expected of the family caregiver? What help can the hospice offer in coordinating and supplementing the family’s efforts or filling in around job schedules, travel plans, or other responsibilities? If the patient lives alone, what alternatives can the hospice suggest?
Does a nurse, social worker or therapist conduct a preliminary evaluation of the types of services needed in the patient’s home? Is it conducted in the home, not on the telephone? Does it highlight what the patient can do for him or herself? Does it include consultation with family physicians and/or other professionals already providing the patient with health and social services? Are other members of the family consulted?
If you are dealing with an agency, are there references on file? Ask how many references the agency requires (two or more should be required.) Does the agency train, supervise, and monitor its caregivers? Ask how often the agency sends a supervisor to the patient’s home to review the care being given to the patient. Ask whether the caregivers are licensed and bonded.
Who can you call with questions or complaints? What is the procedure for resolving issues?
How does the agency handle payment and billing? Get all financial arrangements—costs, payment procedures, and billing—in writing. Read the agreement carefully before signing. Be sure to keep a copy. What resources does the agency provide to help you find financial assistance if it is needed? Are standard payment plan options available?
Does the agency have a 24-hour telephone number you can call when you have questions? How does the hospice respond to the very first call? Does telephone staff convey an attitude of caring, patience, and competence from the first contact, even if they need to return the patient’s call? Do they speak in plain, understandable language, or do they use a lot of jargon about the requirements that patients must meet? What is the procedure for receiving and resolving complaints? How a hospice responds to that first call for help may be a good indicator of the kind of care to expect.
How quickly can the hospice initiate services? What are its geographic service boundaries? Does the hospice offer specialized services such as rehabilitation therapists, pharmacists, dietitians, or family counselors when these could improve the patient’s comfort? Does the hospice provide medical equipment or other items that might enhance the patient’s quality of life?
What are the program’s policies regarding inpatient care? Where is such care provided? What are the requirements for an inpatient admission? How long can patients stay? What happens if the patient no longer needs inpatient care but cannot return home? Can you tour the inpatient unit or residential facility? What hospitals contract with the hospice for inpatient care? What kind of follow-up does the hospice provide for those patients? Do nursing homes contract with the hospice? Does the hospice provide as much nursing, social work, and aide care for each patient in the nursing home as it does in the home setting?
Patient’s rights and responsibilities:
Does the agency explain these? Ask to see a copy of the agency’s patient’s rights and responsibilities information.