Guide to Choosing Hospice Care

Guide to Choosing Hospice Care

Hospice care, sometimes called end of life care, is designed to provide a comfortable and dignified lifestyle when a person is at the end of life. Hospice care is often used for those who are terminally ill and for which there is no further medical treatment possible to cure the condition. This type of care may vary greatly between facilities. Sometimes hospice care is provided in a portion of a hospital or medical facility, in a hospice facility, or in the home.

What to Expect

There are various professionals who may be part of the hospice team. They may include doctors, nurses, social workers, spiritual advisors (clergy), home health aides,  physical therapists, and trained volunteers. Your own doctor can continue to participate in the care plan if you so choose. This may help you feel more comfortable with the care that your loved one will receive.

Hospice Services

Hospices offer many services and try to meet all the needs of their patients, such as:

  • Basic medical care (pain and symptom control, monitoring of vitals)
  • Access to the hospice team 24/7
  • Medical equipment and supplies
  • Counseling and support for your loved one and family
  • Guidance with end of life issues
  • Educating the family on how to care for their loved one
  • Crisis care
  • Volunteer support
  • Grief counseling

The hospice care you choose should be based on the services your loved one requires. It is best to consider an accredited hospice care provider so that you can be sure they follow all of the regulations and guidelines in place for this type of care. Keep in mind that while you may not feel you need a particular portion of their service at this time, your needs and the needs of your loved one could change. As an example, you or your loved one may not be concerned about counseling or support, but as the end of life approaches, there may be a need for it. Keep an open mind when thinking about the services provided and what you may need throughout the process.

Accreditation

A good hospice facility should be accredited by a national accreditation agency. There are three main organizations that provide accreditation for hospice care facilities:

  • Joint Commission on Accreditation www.jointcommissionn.org
  • Accreditation Commission for Health Care, Inc. www.achc.org
  • Community Health Accreditation Program www.chapinc.org

An accredited provider is responsible for adhering to the specific regulations and guidelines that ensure the safety and comfort of patients. Per the Accreditation Commission for Health Care, when a provider is accredited, they have gone through “a process of review that healthcare organizations participate in to demonstrate the ability to meet predetermined criteria and standards of accreditation established by a professional accrediting agency.” This accreditation is a sign of a credible hospice provider.

There may be some good hospice options that are not accredited. Many small and local individual hospice facilities are not accredited. These may still offer the same or even better care as those accredited providers. However, you must be more careful when choosing one of these facilities. If you are considering a non-accredited provider, you should at least inquire as to why they are not accredited and take steps (such as checking references using prior patient families) to verify that they are worthy of your trust.

Crisis Care

Crisis care is an essential part of hospice care. Because of the medical conditions of the patients in hospice, there are certainly going to be situations that require immediate medical assistance. Patients should have a living will in place that specifies the patient’s wishes as to how and when medical treatment should be provided. For example, in some cases a patient may have a “Do Not Resuscitate” (DNR) order in place. This means should the patient stop breathing or their heart stop beating, no lifesaving measures are to be taken (such as CPR). On the other hand, the patient may wish to use all remedies available. This is an example of the personal choices that should be made known so that crisis care can be handled in accordance with the patient’s wishes.

Patient Comfort

The goal of a hospice provider is strictly to keep the patient pain free and comfortable. While nursing care and doctors should be available, the immediate and ongoing concern is comfort. The hospice provider must be prepared to administer the medication a patient needs to be at ease. Before choosing a hospice, make sure they explain and you understand how and when pain medication is prescribed and administered. Remember that if your loved one is in a facility, you will not be present most of the time, so your loved one must be able to communicate discomfort or pain.

Finding Hospice Care

Depending on where you live, hopefully you will find several hospice choices in your area. Here are a few ways to locate the hospice providers near you:

Search online for “hospice in (your city and state)”. If you know that your loved    one will be going to a facility or staying at home for care, you can include the   extra words in your search to narrow it down, such as “hospice facility in (your city and state) or “hospice at home in (your city and state).

Your physician will often have a recommendation or referral that is local to your area. This can be helpful, because your doctor may need to visit the hospice for a period of time, or coordinate and/or direct efforts if you have hospice come to your home.

Your local hospital may suggest some hospice providers or may actually have a hospice on site.

Your insurance provider or Medicare also offers listings of various hospice locations near your home.

You can get a recommendation from a personal friend or relative.

Consider the services offered and other requirements, so when you have narrowed your choices to several potential providers, you can begin doing some more specific research. You should:

Check online to find and read reviews and evaluations. This is a great way to find out what the families of previous patients think of their services.

Ask for references of families who have received their care, and call them. Have your questions ready and written so that you don’t forget anything.

Some hospice providers have small facilities and there could be a waitlist. In some cases, you will be unable to wait, so you will need to choose a different provider.

Visit the Hospice

Ultimately, the best way to evaluate hospice facilities is done through an onsite visit. During the visit, you should tour the facility and gather information about the care provided. At the same time, you can ask questions and meet with the manager to learn more about the facility. You will also get a chance to see how caregivers work and make certain that they offer the various services that you need. When possible, visit at least two or three hospice locations that meet your requirements. You will be provided with a brochure or other detailed information that you can take home with you. This allows you to better review the information and make comparisons of facilities.

Many hospice providers handle both facility hospice care and in-home hospice care. If you are seeking hospice care in the home you should arrange an interview with the provider at the home. This will allow both parties to evaluate the current situation together, and will give you the opportunity to see if you feel comfortable with the provider.

Paying for Care

Hospice care is covered by Medicare and most private insurance. If you are depending on Medicare, a doctor will need to confirm that the patient has a terminal illness and has less than a six month life expectancy. One can still receive benefits beyond six months, but the doctor must confirm that the patient is terminally ill and in need of hospice care. You must also select a provider that is Medicare approved. For more information about Medicare covering hospice care, you can go online to https://www.medicare.gov/what-medicare-covers/part-a/how-hospice-works.html.

When insurance coverage is not sufficient, the patient or the family must pay for the services. Sometimes hospice providers offer reduced rates or free services to those who do not have the finances to pay for the care. It is important to understand billing and payment provisions before you choose a provider.

End of Life

When your loved one is near the end of life, it is typically a time for gathering and final visits. Ask about how the facility provides for overnight guests and find out how many visitors are allowed at a time. It is also important to see whether there is enough space in the room for guests and privacy for the family when needed. When the patient nears the end of their life, the family needs as quiet and considerate an experience as possible.

DISCLAIMER: This guide is provided only for informational purposes and is not intended to be a substitute for legal or other professional advice. This guide does not contain nor is it intended to provide legal or other professional advice for any specific situation and readers should not take action or refrain from taking action, based only on the information provided in this guide. Goldberg & Osborne has attempted to provide accurate and current information in this guide, but cannot and does not guarantee that the information is accurate, complete, or up to date. This guide may contain links and/or search terms that will lead to external websites as a convenience to the reader, but Goldberg & Osborne is not responsible for the content or operation of any website other than its own website. The presence of a link or a search term does not imply and is not an endorsement by Goldberg & Osborne of the website provider or the information contained on any linked website or on any website contained in search results from a search term provided in the guide.