What to Consider When Choosing a Hospice Care Facility

Questions to Ask Your Hospice Provider

  • What are the hospice's admission policies and procedures? How well do these fit your unique needs?

  • From the very first phone call, does the agency project an attitude that is patient, caring, competent and confidence inspiring? Or do you hear a lot of jargon and conditions and restrictions?

  • If you are uncertain about whether hospice is right for you, what kinds of consultation or assessment will the agency offer to help sort out your uncertainty?

  • How quickly can the hospice initiate services?

  • What are the geographical boundaries or other limits to its services?

  • What are its policies on inpatient care and where is the inpatient care provided, if this should become necessary? How long can patients stay there? Can you tour the unit? Does the hospice contract with local nursing homes? Which ones?

  • Is participation in the care by a family caregiver required as a condition of hospice enrollment? What is expected from the family caregiver, and what can the hospice offer to supplement the family's responsibilities?

  • What is the hospice's past relationship with your personal physician? Can they work together effectively? Does the hospice medical director make home visits, when needed?

  • Who provides on-call coverage? What is the average wait to get your call answered when you have an after-hours emergency? How quickly can a nurse come to your home, if that is needed?

  • How often do the nurse, social worker and aide visit typically, and for how long each time? Is it usually the same person? What is the average caseload managed by each nurse?

  • How does the hospice define "palliative" treatments? Are certain treatments automatically excluded? If you require expensive high-technology therapies or devices to manage pain and other symptoms, will this be an issue?

  • What out-of-pocket expenses should you expect?

  • What hospitals and nursing homes does the hospice contract with for inpatient and respite care? The questions and answers above are adapted with permission from "The Hospice Handbook: A Complete Guide," by Larry Beresford, published in 1993 by Little, Brown & Co. This book is still in print and can be ordered through most bookstores.

Things to Know About Hospice Care

  • Hospice is not just for the last few days or the last two weeks. Hospice is designed to care for the patient and family during the last months of life.

  • Hospice is not a "crisis" service. Patients and families should ask their doctor whether curative treatment will work and what burden it will place on the patient. An early hospice admission helps the patient and family get the full benefit of hospice services, including the emotional support and family services.

  • Hospice is not a "place" - it is a kind of care and a set of services. Hospice care is typically delivered in the patient's own home, a nursing home or in assisted living. Other locations can include a hospital or a "hospice house".

  • You do not have to be "ready to die" to receive hospice care. Rather, you should be seeking comfort and an improved quality of life. Hospice is ready to help you and your family make the most of the time that's left.

  • Under normal circumstances, hospice does not provide services in the home around the clock or for "shifts" that allow family members to go to work. Hospice team members provide services during visits that may last 30 minutes up to a couple of hours.

  • You may continue to see your own doctors, whether for your terminal illness or other illnesses

  • You do not need to be homebound to receive hospice care. Many patients get out and some make trips while under hospice care.

  • You may leave hospice care at any time. If you would like to return to curative treatment, discuss it with your hospice team. You will be eligible to re-enter hospice at any time without penalty.

  • Hospice does not conflict with the beliefs of any major religion. All faiths recognize the value of spiritual support, pain relief, symptom management and counseling during the final phase of life.

  • Hospice is not just for the elderly or just for Medicare patients. Hospice serves patients of all ages, from infants to the elderly.

  • Hospice is not a financial burden. Medicare Part A, Medicaid and many private insurers cover hospice services. Most hospices have a sliding scale for poor patients and some provide charity care for the truly destitute. The vast majority of patients and families never receive a bill from hospice.

  • You may decline specific hospice services such as volunteers and housekeeping support.

  • Hospice will neither hasten nor delay death. Hospice seeks to improve the patient's quality of life and allow dying to take place naturally. It will not extend life through artificial or mechanical means. Nor will it shorten life through assisted suicide.

  • There is no limitation on how long you can receive hospice care. True, your physician must certify that you are expected to live six months or less, but hospice services need not end at six months. Hospice care can extend well beyond the original six-month life expectancy.