Choosing a Hospice Provider

            At some point in most of our lives, we will have to make difficult decisions regarding the end-of-life care for ourselves or a loved one.  Certainly, this is never an easy decision, but hospice care has become an increasingly popular choice among those dealing with terminal illnesses.

            Essentially, hospice care is switching from aggressive curative treatment to palliative treatment.  Palliative treatment is the focus on pain and symptom management, in order to increase comfort and quality of life of patients with life-limiting diseases.  Most insurance programs, as well as Medicare and Medicaid, provide coverage for hospice and palliative care.

            The hospice philosophy was founded with a holistic, team-based approach to healthcare.  The team usually consists of a physician, nurse, medical social worker, home health aide, chaplain and volunteers.  Each team member provides a different type of support – physical, emotional, sociological or spiritual – and this approach seeks to address the complex issues that may be present at the end of life for both the patient and the family.  The team works closely with the primary physician and the family to create a specialized plan of care tailored to each individual patient based on need.

            Much has changed in the past few years for hospice, and now there are multiple providers of services in almost every community in the country.  Some of these agencies are not-for-profit organizations that are supported by United Way and other community contributions.  The hospice movement began with these not-for-profits, most starting solely as volunteer organizations.  Within the last decade, large regional and national healthcare corporations have entered the market offering hospice services, and the primary philosophy and even services provided between these two groups can vary widely.  When choosing a hospice, it’s important to know exactly what kinds of support you’ll be receiving, if and how they bill for their services (some do), and whether or not it is a nonprofit organization.  Following is a brief list of questions to ask when choosing a hospice:

• Is the agency a not-for-profit organization?
• Who is the Medical Director?  Is he/she a local physician?  How long have they served in this role?
• How does the agency handle payment and billing? Get all financial arrangements—costs, payment procedures and billing—in writing. Read the agreement carefully before signing. Be sure to keep a copy.  Are standard payment plan options available? What resources does the agency provide to help you find financial assistance if it is needed?
• Is the hospice program Medicare certified?
• How many years has the agency been serving the community? Can the agency provide professional references from hospitals, social workers or physicians who have used their services? A good agency will provide specific names and telephone numbers upon request.  Also check with the Better Business Bureau, local Consumer Bureau, or the State Attorney General’s office.
• What is the frequency of visits for the nurse, home health aide, chaplain and social worker? 
• How quickly can the hospice initiate services? What is its geographic coverage area? How far do they have to travel to reach me?  With a smaller coverage area, there is less travel time in times of need.
• Does the hospice offer specialized services such as massage, music or pet therapy that may be used when medically indicated to improve the patient’s comfort?
• Are there limits on when a patient can visit his/her doctor?
• Does the hospice provide medical equipment or other items that might enhance the patient’s quality of life?

            Clearly, there is a lot to consider when choosing a hospice provider for yourself or a loved one.  If hospice care is an option you’re considering, please speak to your doctor about it or request information from your local provider(s).  Because philosophy and services can vary widely, it’s important to interview more than one agency.  In order to get the maximum benefit from all the services offered, it is crucial to get the hospice provider involved and the patient admitted as soon as possible.  It can make all the difference in the world.

- Written by: Ginny Langbehn, Hospice Family Care (published in Health For America, April, 2006)