When a loved one is diagnosed with a terminal illness, hospice care can provide comfort and dignity in their final days. Hospice care is a type of palliative care that focuses on relieving pain and symptoms rather than curing the disease. It also offers emotional and spiritual support to the patient and their family.
However, choosing a hospice agency is not easy. Many factors must be considered, such as the quality of care, the agency's location, the level of services, and the patient's rights. This article will discuss these factors and provide tips on choosing the best hospice agency for your loved one.
Quality of Care
The quality of care is the most important factor when choosing a hospice agency. You want to ensure your loved one receives the best care and support during their end-of-life journey. Unfortunately, not all hospice agencies provide the same quality of care. According to Medicare statistics, some hospice agencies may have low ratings, high staff turnover, or frequent complaints.
Therefore, it is essential to research and choose a hospice agency with a good reputation for providing high-quality care. You can use the Medicare Hospice Compare website to find and compare hospice agencies in your area. The website includes information on the quality of care, such as how often the agency checks for pain, how well it treats shortness of breath, and how usually it provides care in the home.
You can also ask for referrals from your loved one's doctor, nurse, social worker, or other health care professionals. They may have experience working with hospice agencies and can recommend the ones they trust. Additionally, you can talk to other families who have used hospice care and ask for their feedback and opinions.
Location of the Agency
Another factor to consider is the location of the hospice agency. While the agency's location may not be important, it is crucial to consider where the nurses providing care are located. A hospice agency that covers a large area may not be able to provide timely and efficient care if the nurses must travel long distances to get from one patient to another patient and so on.
Therefore, it is advisable to choose a hospice agency close to your loved one's home or preferred place of care. This way, the nurses can visit your loved one more frequently and respond quickly to any emergencies or changes in condition. You can ask the hospice agency how many patients they serve in your area and how often they visit them. You can also ask how they handle after-hours calls and their backup plan in case of staff shortages or bad weather.
Level of Services
The level of services is another factor to consider when choosing a hospice agency. Hospice agencies vary in their services, such as the number of nursing and social worker visits, access to chaplain or spiritual care, and availability of complementary therapies. Some hospices may also offer specialized care for illnesses like dementia or cancer.
It is important to carefully consider your loved one's needs and choose a hospice agency that can provide appropriate and comprehensive care. You can ask the hospice agency what services they offer and how they tailor them to each patient's needs and preferences. You can also ask how they coordinate with other healthcare providers, such as the patient's primary doctor, pharmacist, or home health aide.
Patient’s Rights
Finally, it is important to know that your loved one has the right to choose the hospice agency they wish to use and to change it if they are not satisfied with the care they are receiving. They can transfer to a different hospice agency once per benefit period, which is usually 90 days. Transferring hospice agencies involves submitting a Notice of Change and providing information about the patient's current and new hospice agencies.
However, transferring hospice agencies may not be easy or smooth. Delays, paperwork, or communication issues may affect the continuity of care. Therefore, choosing a hospice agency carefully and trying to resolve any issues or concerns with them before deciding to switch is advisable.
Interview questions to consider asking
What is the name of the parent company? Or otherwise, what corporation owns the hospice agency? This is critically important because many corporations are buying up mom-and-pop hospice agencies while keeping the exact name of the agency they purchased. This leads to the possibility of interviewing what you think are two separate agencies because they have different names and office locations. Still, they are owned by the same corporation, which means they follow the parent company's rules.
For the registered nurse case manager (the main person with whom the patient and family or facility staff will interact most frequently) who will be assigned, on average, how many patients do they manage? A good average is ten to fourteen; anything higher may mean less frequent scheduled visits and the risk of things getting missed, especially if the RN case manager is new to hospice. Furthermore, if that RN case manager is expected to handle “as needed” events during the work week, the more cases they manage, the harder it will be for them to help in times of crisis.
What is the “Gold Standard” for scheduled nursing and CNA/HHA visits? A suitable number to hear/read is a minimum of two nursing visits per week and two to three CNA/HHA visits per week, with the understanding that the family can request fewer visits per week.
What is the total size of the agency's territory in either counties or miles? How many nurses are available for on-call needs? There is not necessarily a right or wrong answer to this question because everywhere is short-staffed, but this might give you an idea of response time from calling for a crisis after hours to the time the nurse may be onsite. I know of cases where only one on-call nurse was covering nine (9) Pennsylvania counties, and it took the nurse over two hours from one location to a crisis. Please note that since hospice is not EMS, hospice staff such as me and others don't use sirens, lights, or other means of being able to drive faster.
Ask the party you are interviewing how they might minimize the times you have to use on-call and note their responses. In my experience, if the agency is extremely good at avoiding crisis moments, the response time of on-call is not as important compared to agencies that may not be good at managing symptoms that you or your loved ones are frequently calling; then does it matter if they are 15-minutes away vs. two hours?
Ask them what makes them different from other providers you are interviewing.
And if the race is tight, ask to meet face-to-face with the RN case manager assigned to the case, as you might click well with one and not the other.
Conclusion
Choosing a hospice agency is a weighty decision that can significantly affect the quality of care a terminally ill patient receives. While all hospice agencies provide palliative care and comfort, some key differences can impact the level of care and support provided. Therefore, it is crucial to research and compare options before making a choice.
Some factors to consider are the quality of care, the location of the agency, the level of services, and the patient's rights. By considering these factors, you can choose a hospice agency that can provide your loved one with the best possible care and support during their end-of-life journey.
