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

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

For part three of this series I want to deal with the most important question - location, location, location.

I want to say from the top that I am not talking about where the office is located. Many hospices operate out of some really dumpy buildings in really bad locations. Hospice is one of the few businesses where the client almost never visits the office, so many hospices save some money by operating out of spaces that should be condemned. Many hospices operate out of houses instead of office buildings. All of this is to say that you should pay zero attention to what the office looks like or where it is.

Before I explain myself please know that of all the words I spill and all the advice I give in this series on how to choose a hospice this post is the one that should always be a deal breaker. If you talk to a hospice that answers every other question perfectly but fails this test, then you should not use it. I am against huge New York Stock Exchange company operated hospices, but if they are the only ones around that pass this test, then they are the company you should use. The issues I have discussed in the earlier posts hold theoretical potholes on the road to great hospice care. The location issue is not a theoretical one.

You need to know where the on-call nurse lives. No, you don't need to know the address of the nurse's house, but you need to know how far it is from the on-call nurse's house to the patient's residence. When you ask where the on-call nurse lives they are going to say that they have many different on-call nurses. While that is true, it does not answer your question, so ask it again. Keep asking the question until you know the answer.

Here's why this is important. The odds are very high that the patient you are shopping hospices for is going to wake up in pain, have seizures, fall out of bed, halocunate, or stop breathing while on hospice service. If this happens at 2am, then the amount of time between when the problem starts and when you can start finding a solution depends on how long it will take for the on-call nurse to get from their bed to the patients bed. It is that simple.

Remember from post number two in this series, our example hospice can cover anyone within 50 miles of their office, and with branch offices they could cover 99 miles from the home office. The hospices that trouble me most are ones who use one on-call nurse to cover multiple branches. Let's do the math. If the patient lives 40 miles north of the northern branch office and has a crisis (almost all hospice patients have a crisis) and the on-call nurse is visiting a patient that lives 40 miles south of the home office, then she will have to drive 40 miles north to get to the home office, 49 miles north to get to the branch office, and 40 miles further north to get to the patient. Your loved one is having a medical crisis and the nurse will have to drive 129 miles before anything can be done. That is 100% unacceptable! First rule of thumb, make sure there is always someone from the office closest to you that is on call. Second rule of thumb, make sure they are not covering call for other offices. The on-call nurse being your next door neighbor will not help you if she is with another patient 90 miles from home at your time of need.

The third rule of thumb is, if you live in the same town as the hospice office, make sure that their on-call staff lives in town also. Choosing the local hospice doesn't do much good if they hire on-call nurses that are not local. If the main on-call nurse lives 30 minutes from town, then you'll have to wait at least that long before help arrives. There may not be a hospice in your area that can promise that the on-call nurse will live close to you, but if there is, then that is almost always going to be the hospice you should use.

To summarize: Where the on-call nurse lives is probably the biggest thing you need to know before making your hospice decision. I'd rather use an unethical/money grubbing hospice that can promise quick response time than a great one that will make you wait an hour before they can get you. On a personal note, I believe my company and my staff are as good as any hospice could be, but I have told many possible patients that they should call another hospice because of this exact reason. If you are choosing between a 15 minute response time and a 45 minute response time, it should be a no-brain decision.

There are five more parts to this series. Next find out why pharmacies matter.