This is end of life care which may be provided in your home or at a designated facility such as a hospital or nursing home.

If life expectancy is six months or less  or  curative treatments are no longer working and/or a patient no longer wants them, then choose hospice.  They will not offer cures, but rather comfort items such as medications for pain.  Also see links in my blog about hospice .

Levels of care (1):

routine home care ……...medications, nurse visits, physician consults, spiritual counsel

continuous care………… in the patient’s home, more intense care

general inpatient………...Facility: freestanding; part of a hospital or long term care

respite care……………… up to 5 days of inpatient care to give family members a break

Note that Medicare (2) pays for most hospice care but pays a flat per diem rate regardless of the care needs of the patient.  However, I’d advise you to get the latest hospice info from Medicare since laws change.

Questions to ask:

  1.  Where is the staff located?  You don’t want them to be 50 miles away.
  2. There should be full-time medical director available full-time to make home visits, consult with other physicians, and act as a resource for nurses and one on call 24/7.
  3. Is there a case manager nurse directing your care? There should be the same nurse who visits you every time .  Are their nurses licensed or registered? Registered is preferred.  If they are certified for palliative care (CHPN)  that indicates this hospice cares about quality.  How many patients are assigned per nurse?  If more than 10, care may not be as good.
  4. Do they have home health aides to provide personal care?  How often do they visit and how long do they stay?
  5. Are they accredited?  By whom?
  6. Do they have social workers?
  7. Do they have a chaplain?
  8. Are there volunteers?  Are they there because this hospice dis a good job for one of their loved ones?
  9. How long have they been in business?
  10. Is this a for-profit or not-for-profit agency? This matters because medicare pays a flat rate per patient per day while patient needs vary greatly.  If it’s a for-profit hospice, are they choosing patients with less care needs and/or the potential of longer lives?  Dementia for example may require less service than a terminal cancer patient. See the article for details (3).
  11. Pharmacy - how close is it?  How easy to get medications when you need them? Does the hospice provide you with an emergency medical kit so the patient doesn’t have to wait hours for help if there’s an emergency?
  12. What local facilities do they work with should the patient need care in a facility?
  13. Advantages and disadvantages  of hospice  range from less cost to you to not being allowed to enroll in clinical trials.





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