How To Choose a Hospice: Why Management Matters (updated)

(This post is part of a series of posts. To read from the begining of the series go here.)

Part three is an easy follow up question to the one you asked in part 2. Now that you know who owns the company, you need to know how many offices they have, where the offices are, and which one is the home office. You now need to know if the "big cheese" works out of your local office. (I use "big cheese" because this could be different people with different titles for different hospices. If the owner actually works for the company, then clearly the owner is the big cheese. The big cheese's desk is the place where the buck stops. You need to know who the big cheese is and where he/she works.

You need to understand three things to understand why this question is important.

1. First, most states limit how much territory any one office can cover. My hospice is allowed to admit any patient that lives within 50 miles of the office in any direction. If it is 51 miles to your house, I can't help you. To expand the area a hospice can cover all you have to do is open a branch office. Each office has its own 50 mile radius, so by opening a branch 49 miles from the home office you can serve patients 99 miles from the home office. If possible, you want to work with the big cheese's office. The nurses at that office have direct access to the person who makes the decisions. Branch offices rarely have any employees who make business or financial decisions. Those offices are staffed with clinical employees who must call the home office to get answers to business related questions, which leads to the second thing you must understand.
   
2. It is easier to be mean or heartless over the phone than it is face to face. If a nurse walks into the big cheese's office and asks for something that is good for the patient but bad for the checkbook and the big cheese tells her no, then the big cheese will have to look her in the eye every day knowing that she thinks he's a greedy heartless SOB. If the nurse calls from an office that the big cheese almost never visits and asks the question, then he doesn't have to worry as much about dirty looks or the lost respect of a coworker. The more detached the big cheese is from the patient, the easier it is for the big cheese to lose perspective of what is important. I meet many of the patients from our home office, but would rarely meet a patient from a branch office.
   
3. Third, you must remember that the cream rises to the top. The top is always at the home office. The head nurse at the home office is the boss of the head nurse at the branch office. As a nurse gains experience they are naturally going to gravitate toward the home office. I'm sure there are exceptions to this rule but generally the home office is going to have better staff than the branch office. If you are choosing between two hospices and one is a home office and the other is a branch, choose the home office.
   

Remember, our goal here is to choose a hospice that will do everything possible for the hardest of patients. With that in mind, do you think it is in your best interest to work with a hospice where the big cheese is detached from or ignorant of the issues your loved one is dealing with? I didn't think so.

All right, I promise that I'll get off my anti-corporate hospice bandwagon for the next post where I'll discussion location, location, location.