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How to Choose


Choosing the best hospice provider for the patient is very important, although not necessarily as difficult as you might think. It just requires a little preparation to ensure that you can ask relevant questions that may affect the experiences of those involved.
 

Most hospices offer the same basic services


Hospices that participate with Medicare, and most do, provide the same basic services. However, there still may be differences between providers that might make one a better choice for you over another. The best way to really know – is to compare.

Generally, with Medicare, the choice is limited only by the location of the patient. In many communities, this means there may be several providers from which to choose. However, some insurers other than Medicare may require you to first consider a “preferred provider” with which the insurance company has negotiated favorable rates, in order to receive the full financial benefit of your policy.

Medicare recently launched the website, Hospice Compare, which provides lists and ratings of hospice providers in your community. 
 

Quality Care


Under the Affordable Care Act, Medicare-certified hospices must collect and report quality measures to the federal government, and the federal government is to make data on hospices available to consumers.  Although this process has begun, the data may not be publicly available until 2017. The Washington Post has developed a way to compare some basic information about hospices through an online database. You can access that database here.

At present, a hospice must meet state and local regulations for operating as a business but accreditation for the quality of the care and services it provides is voluntary.  Many hospice programs seek accreditation by the Joint Commission or by the Community Health Accreditation Program, agencies that measure a provider’s quality of care against best practices and standards.  However, lack of accreditation does not necessarily mean the quality of care is substandard.
 

Narrow down the choices


There are many ways to determine which provider(s) to consider. One of the best is by word-of-mouth, particularly if a relative or trusted friend will share their hospice experience. Often, the hospital discharge planner or social worker will have a list of local providers. Your physician not only may have a list of providers, he/she may offer to share their professional experience with the hospice provider for you to take into consideration. Once you know which provider(s) to consider you can set up informational appointments with one, some or all.
 

Conduct interviews


You should expect any potential hospice provider to send a representative to meet with the patient (if he/she is able) and the family/loved one/main caregiver in order to discuss the services provided and answer questions. Make sure there will be no charge for this visit and no obligation to choose that provider. If at all possible, prepare questions before the meeting so that you can concentrate on the answers.

Here are some suggestions:

What is the typical response time if we need to reach someone at the hospice after normal business hours, or on weekends and holidays?

How quickly will a plan of care be developed for the individual by the hospice?

How quickly can we expect pain and/or symptoms to be managed?
 
How quickly will the hospice respond if medications do not seem to be sufficiently addressing pain or symptoms?
 
What does the hospice do when someone's pain cannot be adequately managed at home?

If there is a need for inpatient care, how will that be addressed by the hospice?
 
Are there any services, medications or equipment that the hospice doesn't provide?

What kind of out of pocket expenses should the family anticipate?
 
How often will a hospice team member visit and how long will most visits last?

When the hospice orders medication, where can it be picked up, or is it delivered by the hospice?

Do members of the team providing care have additional training and certifications for their hospice and palliative care skills?

What is expected of the family caregiver?

Will the hospice provide training to family caregivers?
 
Can the hospice provide respite care to give family caregivers a break and how does the hospice arrange that?

What help do your hospice volunteers provide and how can we request help from a volunteer?
 
Does the hospice measure quality of care and does it have any quality data it can share?
 
What kind of bereavement support is offered by the hospice?

If we are unhappy with some aspect of care the hospice is providing, who can we contact at the hospice?

Find 16 more questions to ask here
 

Consider what is important to you


Besides the answers to your specific questions, consider the “chemistry” (or lack of) with the hospice representative. Although that individual may not be someone directly involved in your care, you should feel comfortable with whomever the hospice has sent to make a first impression.  As with any other important decision, try to take time to make an informed choice. 
 

Special considerations


One of the (many) reasons hospice has earned its reputation is its commitment to serving anyone medically eligible for its services. This first became evident decades ago when hopices rose above the predominance of fear and ignorance of HIV and compassonately served people dying from AIDS. Today, you should expect a hospice to routinely care for people in the LGBT community, those with intellectual or developmental disabilities, and those who do not speak English. Look to the sidebar on the right to find resources for different communities.