When a loved one is diagnosed with a terminal illness, can provide them with comfort and dignity in their final days. is a type of that focuses on relieving pain and symptoms, rather than curing the disease. Hospice care also offers emotional and spiritual support to the patient and their family.

However, choosing a is not an easy task. There are many factors to consider, such as the quality of care, the location of the agency, the level of services, and the patient's rights. In this article, we will discuss these factors and provide some tips on how to choose the best for your loved one.

Quality of Care

The quality of care is the most important factor to consider when choosing a hospice agency. You want to ensure that your loved one receives the best possible 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 do your research and choose a hospice agency that has 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 provides information on the quality of care, such as how often the agency checks for pain, how well they treat , and how often they provide care in the home.

You can also ask for referrals from your loved one's doctor, nurse, , or other health care professionals. They may have experience working with different hospice agencies and can recommend the ones that 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 location of the agency itself 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 that is 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 what their backup plan is 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 the services they offer, such as the number of nursing and visits, access to or spiritual care, and availability of complementary therapies. Some hospices may also offer specialized care for specific illnesses, such as dementia or cancer.

It is important to carefully consider the needs of your loved one and choose a hospice agency that can provide appropriate and comprehensive care. You can ask the hospice agency what services they provide and how they tailor them to each patient's needs and preferences. You can also ask how they coordinate with other health care 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. They also have the right to change their hospice agency 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. The process for 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. There may be delays, paperwork, or communication issues that can affect the continuity of care. Therefore, it is advisable to choose a hospice agency carefully and try to resolve any issues or concerns with them before deciding to switch.

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 an increasing number of corporations are buying up mom-and-pop hospice agencies while keeping the same 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, but they are owned by the same corporation, which means they follow the rules of the parent company.
  • For the registered nurse case manager (this is the main person with whom the patient and family or facility staff will interact with 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 as well as the risk of things getting missed, especially if the RN case manager is new to the field of 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 scheduled 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 the family can request fewer visits per week.
  • What is the total size of the agency's territory in either counties or miles? Along with how many nurses are available for needs? There is not necessarily a right or wrong answer to this question because everywhere is short staffed, but this might be able to give you an idea of response time from calling for a time of crisis after hours to the time the nurse may be onsite. Personally, I know of cases where there was only one nurse covering nine (9) Pennsylvania counties where 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 calling frequently; then does it really 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 that would be 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 and comfort, there are some key differences that can impact the level of care and support provided. Therefore, it is crucial to do your research and compare options before making a choice.

Some of the factors to consider are the quality of care, the location of the agency, the level of services, and the patient's rights. By taking these factors into account, 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.

Resources

What's the process of getting your loved one on hospice service?

Medicare — Find and compare hospice providers

Providing Comfort During the Last Days of Life with Barbara Karnes RN (YouTube Video)

Preparing the patient, family, and caregivers for a “Good Death”

Velocity of Changes in Condition as an Indicator of Approaching Death (often helpful to answer how soon? or when?)

The Dying Process and the End of Life

The Last Hours of Life

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Gone from My Sight: The Dying Experience

The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Death

By Your Side , A Guide for Caring for the Dying at Home

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