How To Choose a Hospice: Why Some Things Don’t Matter

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

This is my final post in the How to choose a hospice series for now. As time goes on, I'll think of other suggestions, but nine is enough for now.

In this post I'll tell you a few of the things that don't matter and some that do. Most of this post is in response to other websites that have lists of things that are important when choosing a hospice. Some have good suggestions, some are silly, and some are downright self serving. Here's my list of what is and is not important:
What doesn't matter:

• The for profit/not-for-profit status of a hospice. You will hear non-profit hospices preach that for-profit hospice is the most evil thing in the history of civilization, but it just isn't true. There are bad non-profit hospices. There are good for-profit hospices. It all goes back to the heart and intentions of the owners and staff of the hospice.
  
• The extra community service things the hospice offers. Hospices that offer grief support to the whole community or grief camps for children who have lost parents are great, but what does that have to do with your loved one's care? If you want to support those efforts, then donate money. If you want the best care possible for your loved one, research the actual hospice operations of the company you are choosing. (Let me emphasize again, that I have a lot of respect for hospices that go above and beyond with these types of activities and think every community needs someone to provide these services. All I am saying is that the fact that a hospice operates a great kids camp has very little correlation to caring for terminally ill patients.)
  

What doesn't always matter:

• Membership in NHPCO. Any hospice in the nation can become a member of NHPCO, what is important is active membership in NHPCO. Paying dues to the national organization does not increase the quality of care. Being an active participant in the organization will, no doubt, increase the quality of care. When evaluating a hospice, ask them if they send their staff to NHPCO conferences. Bearing that expense for the sake of making their employees better is a sign that the organization is dedicated to quality care.
  
• Membership in state hospice organization. (See Membership in NHPCO. Active membership is a much better indicator than just membership.)
  
• CHAP or Joint Commission Accreditation. While these accrediting bodies do have some helpful regulations that hospices must abide by to obtain and keep their accreditation, they also have many regulations that make no difference at all. Accreditation is usually associated with larger hospices or hospices that are a part of a hospital system. It is not easy, it is not cheap, and it is in many ways not relevant. Clearly being accredited is never a bad thing, but in the end accreditation does not always equal quality care.
  

What does matter:

• Medicare Certification (the baseline requirements for a hospice to be able to do a good job)
  
• Do they take your insurance? Ask them, don't just check your book, because hospices can usually get a one-time contract for a patient.
  
• Specialty accreditation for nurses or other staff members. If a hospice encourages/allows its employees to take the time and effort to be accredited in their field, then you can probably assume that the hospice is focused on quality. A hospice that has a large number of Certified Hospice and Palliative Nurses (CHPN) is most likely one that is focused on care.
  
• The NHPCO Quality Partners Program. In brief, this program is an attempt to quantify the quality of care provided by a hospice. It is an optional program offered by NHPCO and one that takes a signifacant amount of time and energy. Any hospice that has signed the Quality Pledge and is actually participating in the program is moving in the right direction. Once this program is fully operational you won't need this blog to help you identify a quality hospice because the Quality Partners program will have done it for you; until then, it is probably safe to assume that any hospice willing to voluntarily participate in the program is probably dedicated to quality.
  
• The Medicare Hospice Cap. You need to know if a hospice has a "cap problem". There are a lot of posts on this subject on this blog, so I will not begin to try to explain the details of what the cap is here. If you want more information just search the blog for the word cap. A hospice that has a "cap problem" owes Medicare money. Some of them owe Medicare a lot of money. There is no published list of which hospices have cap problems, so you'll have to rely on them telling you the truth when you ask if they have a cap problem. You don't want to use a hospice that is trying to scrape together a pile of money to pay Medicare their cap money. While it is unfortunate that the hospice is facing this problem, it isn't your problem. Choosing a hospice that has a cap problem could be risky no matter how great the hospice seems. (Past performance doesn't guarantee future results, especially when the game has been changed by a cap issue.)
• Finally, a hospice that has a full-time medical director or a medical director who is willing to make home visits would be a real plus. I'll quote Christian from Pallimed on this one since he is a full time Palliative Care Doctor.

"I think there is a large advantage to the patient, and family in having a full-time board certified medical director, who is actively involved in many parts of the hospice, including home visits, consulting with other doctors, providing expertise to nurses in the field in delicate situations. Having a medical director who only attends team meeting for 1-2 hours a week but is otherwise not involved in clinical care can be satisfactory, but when a hospice patient or family is in a tough spot and needs some medical expertise, it can fall apart. The full-time medical director who is board certified can help bridge the gap when symptoms get very difficult to control. That is a great resource for a hospice and the communities it serves."

That's it for now. I hope this series has helped. Feel free to ask questions, because your questions may help me understand the parts of this puzzle that are unclear or see what I have forgotten.