It’s important to be well informed about a hospice agency that you’re considering to provide services to you or your loved one. The following are suggested questions to ask when deciding on a hospice care provider:
Accreditation: Is the hospice agency accredited by a nationally recognized accrediting body such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)? If a hospice has voluntarily sought accreditation, this indicates the organization is committed to providing quality care. The JCAHO is an independent, not-for-profit organization that evaluates and accredits healthcare organizations and is an important indicator in determining the quality of healthcare services provided.
Certification: Is the hospice program Medicare certified? Medicare certification means the program has met federal minimum requirements for patient care and management. Note: The hospice provider must be Medicare-approved to receive Medicare payment for its patients. To find out if a certain hospice provider is Medicare-approved, ask the hospice provider, check the HospiceDirectory.org website, or consult your state hospice organization (see the “Resources” page of this web site).
Licenser: Is the program licensed by the state if your state requires this?
Consumer information: Does the hospice provide written materials outlining services, eligibility criteria, costs, payment procedures, employee job descriptions, malpractice, and liability insurance?
References: How many years has the hospice been serving your community? Will it provide references from professionals, such as a hospital or community social workers, who have used its services? It should be no problem for the hospice to provide such references. You may also wish to check with the Better Business Bureau, local Consumer Bureau, or the State Attorney General’s office to see if there have been any complaints about the organization.
Admission policy: How flexible is the hospice in applying its policies to each patient and negotiating differences? If you’re uncertain whether you or your loved one qualifies for hospice, or whether it’s appropriate at the time, is the hospice agency willing to conduct an assessment to help you make a decision?
Plan of care: Does the hospice organization create a plan of care for each patient? Is the plan carefully and professionally developed and include input from you and your family? Is the plan of care written out and copies provided to all involved? Make sure the care plan lists specific duties, work hours/days, and the name and telephone number of the supervisor in charge. Make sure the agency routinely updates the care plan as the patient’s needs change. You may wish to ask if you can review a sample care plan.
Physician collaboration: How will the hospice physician collaborate with the patient’s doctor?
Staff workload and communication with patient and family: How many patients are assigned to each member of the hospice care staff? Does the hospice staff meet regularly with the patient and family to discuss care?
Family caregiver: Does the hospice require a designated member of the family to be the 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, and will it accommodate job schedules, travel plans, or other family responsibilities? If the patient lives alone, what alternatives to a live-in caregiver does the hospice suggest?
Preliminary evaluation: Who on the hospice staff conducts the preliminary evaluation of the types of services needed in the patient’s home (nurse, social worker, therapist)? Is this evaluation performed in the home or over the telephone? Does it include what the patient can do for him or herself? Does the evaluation include consultation with family physicians and/or other professionals already providing the patient with health and social services? Are members of the family consulted for their input?
Personnel: Does the hospice agency train, supervise, and monitor its caregivers and volunteers? Ask how often the agency sends a supervisor to the patient’s home to review the care being provided to the patient. Ask whether the caregivers are licensed and bonded.
Assistance/Complaints: Which person at the agency should you call with questions or complaints? What’s the procedure for resolving issues?
Costs: How does the agency handle payment and billing? Be sure you’re provided with all financial arrangements—costs, payment procedures, and billing—in writing. Read the agreement carefully before signing, and keep a copy. If you need financial assistance, what resources does the agency provide? Are standard payment plan options available?
Telephone response: Does the hospice have a 24-hour telephone number to call when you have questions or concerns, prior to or after enrolling in hospice service? If you’ve called the 24-hour assistance line, did the individual answering the call convey an attitude of caring, patience, and competence? Did they speak in plain, understandable language? Were you provided with a satisfactory answer during the conversation, or was your question referred to another person and did you receive a prompt call-back? Your first experience calling a hospice provider is a great indicator of what kind of care you can expect.
After-hours emergencies: How does the hospice staff respond to after-hour emergencies?
Services: 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 if these would improve the patient’s comfort? Does the hospice provide medical equipment—such as hospital beds, walkers, etc.—or other items to increase the patient’s comfort and safety?
Inpatient care: What are the hospice program’s policies regarding inpatient care? Where is such care provided? What hospitals contract with the hospice for inpatient care? What are the requirements for an inpatient admission? How long can patients stay in the hospital? What happens if the patient no longer needs inpatient care but cannot return home? What kind of follow-up does the hospice provide for those patients? If the hospice has its own inpatient unit or residential facility, ask for a tour. If the patient is in a nursing home, does it have a 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: Ask to see a copy of the agency’s patient’s rights and responsibilities information, and request an explanation of anything that’s unclear.