(This post is part of a series of posts. To read from the begining of the series go here.)
No matter what they tell you, size does matter. To be honest, I can't decide how much it matters. That means that while this post is good advice, it is not as important as many of the other suggestions you'll receive in this series.
You don't want a hospice that is too big. You don't want a hospice that is too small. You want a hospice that is just right.
What is too big? I'd say anything over 90 patients in any given office. Make sure you find out how many the office closest to you has, because there are companies that have one huge office and many other offices that are a better size. You should only care about the office that you will be working with. As a hospice grows larger there is no way to avoid it becoming a more impersonal operation. The more patients one person oversees the more they become numbers and not real people. If the person who is making big decisions about your care doesn't know you or much about you, then you are not going to get anything better than routine care. Hospice patients often want or need something special or out of the ordinary; the larger the patient load the less likely that is going to happen.
What is too small? Less than 10 for sure, and probably less than 20. To find out if a hospice is too small ask how many full time Case Managers they have. A case manager is the head nurse for a patient. She is usually a RN, and is basically the person in charge of the patient. Most full-time Case Managers have 10-14 patients. If a company only has one Case Manager, they are too small. That Case Manager may be (and probably is) great, but you must ask what is going to happen when the Case Manager goes on vacation or has the flu. If the only nurse is sick, then the patients are not going to get good care; there is no way around that. Small hospices do awesome things for patients because they can focus intensely on one patient, but when the wheels fall off the bus, a small hospice can get in real trouble quickly.
What is just right? I don't know. There are a lot of factors that go into that question. I guess I'll say that 40-50 patients with five full-time Case Managers would be just right. That is not the size of my company, and few are going to be that size.
As I said at the start, I'm not sure how important size is in the grand scheme of things. I have no doubt that large hospices can give great care. It just takes a lot more effort on their part to keep everything personal. I also know that small hospices can be the best around, but they run the risk of one good stomach virus making them useless.
In the end, the real question probably is how many patients does each case manager have? I think 10 is a great number, but know that profits come when you get to 12 or so. Ask the hospice you are interviewing how many patients they have and then ask them how many full time Case Managers they have. Doing the math may tell you if they are overstaffed or understaffed. Overstaffed is bad for business but good for patients, so unless you are thinking about buying stock in the company choose one that is overstaffed.
2 comments:
i have only worked for a pvt for profit hospice- rn's manage anywhere from 10- 25 depending on the cencus-
we average around 30 $ an hr and have 5 weeks off a year
our team of nurses(5) each take turns doing on call 1 night a week unless the weekend oncall nurse quites.( our travel distance is huge)
i am hopsice certified and love it- but i'm not sure if a not for profit would give me more patient time- what do you think?
While I agree that size may play a role for some patients, in my experience (going on 12 years at a large for profit hospice), most elections occur without regard to size. And I don't agree with your assertion that a hospice with more than 90 patients is too big to provide personal, compassionate care. Our surveys routinely come back with highly satisfied responses over 80%. However, asking a hospice questions about coverage, number of case managers, etc is probably a wise thing too. The NHPCO's latest statistical report shows that over 80% of hospices serve less than 100 patients and many of these probably do have reduced case management coverage because of their size. In addition, the number of hospices continues to increase making choice and selection more complicated.
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