What to Ask When Looking For a Hospice
We Are Not the Same
By Victor Montour
When people are trying to make decisions about which hospice to enroll in, most want to choose a hospice that will deliver the best possible care for whatever time they have left. With the vast number of hospices in the area and the ongoing local press grouping the area hospices as if we are all the same, we thought it was time to revisit this very important topic.
Hospice care is not just hospice care. The care you receive from a hospice agency will vary. WE ARE NOT ALL THE SAME. Each hospice agency has their own staffing model, policies and procedures, response time to a patients needs and so on. As you may know from our Hospice Survey blog, in the past not all hospices measure patient outcomes or quality improvement. Just recently all hospices are required to collect this data and make it public to the consumer. The down side to this is the consumer will not see these results until sometime in 2017 unless they ask. If you haven’t read our blog “Hospice Survey” I encourage you to read it next. Front Range Hospice has been collecting data for years so we can prove that our patients and families receive legendary end of life care. So in an effort to assist you again, here is a list of questions you or your family need to know and ask while looking for a hospice agency to help you.
- A a consumer you have the right to choose the hospice of your choice. It is unlawful for a healthcare professional to pressure you or make you use a hospice that you have not chosen.
- You can ask your doctor for advice. Your doctor may be able to tell you the names of the hospices he or she have used in the past and their experience working with them. But also ask your doctor if he or she has a financial relationship with that hospice. Some doctors are employed by hospices, and may have a financial incentive to refer. Patient’s choice trumps doctor’s choice. That is the law.
- If a referral to hospice needs to be made while you’re in an acute care hospital setting, again you will want to ask if the hospice is affiliated to or owned by the hospital. Some hospital systems strongly encourage their staff to refer to the hospital owned hospice with little regard to the patient’s wishes or choice. Remember you have the right to choice and must be allowed to choose the hospice you want to use.
- A hospice that is owned or affiliated with a hospital is not the same as a hospital that has a preferred provider relationship with a hospice. These relationships are developed over time and are the result of the hospital’s experience with that hospice. Do not be afraid to ask how that decision came about. A hospital usually makes that decision based on the responsiveness, the feedback they receive from patients and families, the quality data and
As you are doing your due diligence I recommend you call the hospices in your area. Set up a time to interview your choices. During this interview you as a consumer should find out what you can expect from the hospice. Use this scorecard as a guide: Scorecard
- What services they provide? And when are the services provided? Listen to see if the hospice will work around your needs and preferences or are you put into a model of care that is centered around the hospice and its staff.
- What is the nurse to patient ratio? The National Hospice and Palliative Care Organization staffing guidelines recommend 10-12patients per registered nurses, 30 patients for social workers and 40 patients for chaplains.
- Does the hospice provide all four levels of hospice care?” (That’s routine home care, inpatient care, continuous care at home, and respite care). Medicare-certified hospices are required to provide all four, but many don’t. To learn more about the four levels of care in hospice check out our blog Do You Know The Four Levels of Care
- One of the most important questions to ask: “Is your hospice certified by The Joint Commission (TJC) or the Community Health Accreditation (CHAP)?” This is voluntary participation by the hospice and a commitment to meet the highest standards in the industry. TJC is considered the Gold Standard. Surveyors from these organizations visit and inspect hospices regularly. As a consumer you have the right to see the results from the inspections. You will want to look for any patient care issues. A hospice with a large number of deficiencies, especially in patient care should be avoided as a consumer.
- Another very important question to ask is “Are your physicians board-certified in hospice and palliative care?” This is a good indication that a hospice takes its medical care very seriously.
- You will want to ask the hospice “do you allow your patients to utilize their primary care physician (PCP) while receiving hospice services?” If the hospice tells you that you have to use the hospice physician, beware again. As a consumer you have the right to use your PCP as the physician to direct your care on hospice. This being said, you may have to change physicians if you choose to be placed in a skilled nursing facility or are receiving care in a facility that only allows physicians to provide care that are credentialed to provide care in the said facility.
- Ask “Does the hospice measure and improve the quality of care that they provide to their patients”? If they reply yes your next question needs to be How?” Any hospice that doesn’t have a quick and clear answer for this question probably isn’t serious about patient care. Then ask “can I see the results?” If no, move on. If yes look at the data, ask questions, and make sure that the data comes from an independent 3rd
- Does the hospice have any special programs or other certifications?
- You could ask what makes their hospice stand out among the rest.
Finally, one last word of advice. Choosing wisely takes time. So start thinking early about what hospice you’d want when the time comes. How early? People typically enroll in hospice very late. More than half of patients in the U.S. enroll in the last three weeks of life, and about a third enroll in the last week. That’s too late to make careful decisions. So start asking questions now. Think of it as insurance, so when the time comes — as it will, for most of us — you’ll be ready to make a thoughtful choice that is consistent with your preferences.
If you would like more information about Front Range Hospice please call 303-957-3101 or 970-776-8080 or email us at firstname.lastname@example.org