You may have heard the words, this is “not curable”, “there is very little we can do” or “I think you need to have a palliative consult.” After the heart sinks and you have worked through the emotional shock, finding a Hospice provider that is the best fit for you and your loved ones is pivotal. The following article addresses the questions to ask, where to find the best hospice for your situation and how to navigate the hospice world.
STEP ONE: Finding the Right Hospice
- Ask your providers; many have affiliations and relationships with hospices and may be able to give you information about specific hospices in your area.
- Ask your church members or clergy. Word of mouth is the best advertisement there is. This is especially important in rural communities.
- Look them up under their governing body: Flashy billboards, being able to make commercials, or having large/flashy advertising can seem as if that is the way to go, but I suggest you really investigate what ratings the government and patients are giving them. The following links are to the regulatory survey and inspection results of the hospice programs.
S&C QCOR Home Page (cms.gov); CMS is the standard in all hospices. If the hospice accepts Medicare or Medicaid, consider this the mecca.
Hospice Rating: This is the simplest of all the ways to access survey results. I highly recommend that you do this with all the hospices that you inquire about.
Hospice Compare – Find a Hospice Agency (healthcarecomps.com) I love this site, as it gives you the national averages and where the hospice is in comparison. It also lists competing hospices in the area and provides tips on questions to ask.
STEP TWO: Interviewing the Hospice
Ask for a consultation or an “informational” meeting. This should be a no-pressure interview, not a sales tactic. This could be with the hospice social worker, director, or administrator but the person should be well versed in the hospice benefits and what makes them special.
- Ask about response times. We have had patients transfer to Generations due to poor response times from other hospices. It is important to remember that some hospices may come from surrounding cities, and this could push response times well over 2 hours.
- How is medication managed? This may seem like a simple answer, but it is not. If the patient is at home, managing meds can be stressful. How do they provide education? How does the hospice handle special cases such as an individual needing meds set up, or a locked device to keep meds safe?
- Who is the Medical Director? Not all hospices provide a medical director that is hospice certified. Medical directors are medical doctors who lead the hospice team in how to treat your loved one. Having a medical director who is certified in hospice care can be a saving grace.
- Ask if they are comfortable with using the patient’s provider and how do they obtain orders and communicate with the provider. CMS (Medicare guidelines) is clear that we must offer to use the primary care physician and that the provider participates in the Interdisciplinary Group and decision-making processes.
- Make sure that the consultation includes a conversation about goals for the patient, that spiritual needs are discussed and that there is genuine concern for the patient and their end-of-life wishes and desires.
- Ask about hospitalization and further treatment. There are guidelines from CMS that have to be followed in order to continue on hospice. This should be discussed at the first encounter.
- Ask about family involvement. What education will they provide to help the family with the grieving process? This is particularly important if there are children involved.
- Every hospice has a way of surveying families after their loved one has passed. I recommend asking about their individual surveys. This is going to tell you a great deal about how well the hospice does with the overall care.
Choosing Hospice is emotional and tough to do; make sure that you are asking questions and that you listen to your gut. It is okay to ask for consultation from more than one hospice.
WHAT TO DO AFTER YOU HAVER CHOSEN A HOSPICE PROGRAM:
Things will seem overwhelming at first. The admitting hospice has assessments to do, and education to provide and they are in a hurry to make sure that their patient is comfortable. Some things should happen rapidly, but once routines are established this should all slow down to a routine pace. But what if you have concerns that are not addressed, you feel as if the hospice is less attentive then they should be, or it just does not feel like it is a good fit? It is okay to transfer hospice or to even revoke.
CMS (Medicare guidelines) states that a transfer can happen one time in each certification period. Revocations can be done and should your loved one need it later; the patient is just started in a new certification period. It is just paperwork and documentation.
We spend hours researching a good OB/Gyn for a new baby on the way, we ask for second opinions when we are given life-changing news so why shouldn’t we give the respect that end-of-life planning deserves? Please feel free to call us at Generations Hospice care anytime for any questions that you may have. We are here for you and your family!!
