how to choose hospice why it matters

Monday, March 07, 2005

How to choose a hospice: why it matters

This is the first in a multi part series on how to choose a hospice. The later posts will go into detail about what you need to know and how to find out, but before I get into all of that I wanted to talk about why it matters.

If you pump truth serum into most hospice workers they will tell you that there isn’t much difference between their company and the others, and in reality there isn’t. We all work under the rules of the Medicare Hospice Benefit. Medicare tells us what staff we must have, what we must pay for, who does and does not qualify for hospice, how often we can or can’t do certain things, who we contract with to provide certain services, and even who we can’t contract with. The Medicare Hospice Benefit rules hospice in the United States today. With that fact in mind, I’m going to tell you what you need to know before choosing a hospice for your loved one.

I’m sure you are wondering why I’m writing multiple posts about how to pick a hospice if I start post number one by saying that most hospices are the same. The answer is simply: “Because the devil is in the details”. If you call three different hospices and ask general questions about what they do and don’t provide for their patients, you will hear almost the exact same thing three times. Does that mean that it doesn’t matter which one you choose? NO! There are not many differences between hospice programs, but those little details that you don’t even know to ask about could become a big deal for your loved one.

In all honesty, I believe that most hospices do a good job of taking care of the average patient. The differences come when dealing with the rare patient or rare situations. You never know which patient is going to be average and which will present something rare. I’ve seen quite a few hospice patients, and would not ever attempt to guess at which one is going to surprise me tomorrow. This whole set of posts is written just in case your loved one falls into the rare category, because if they do then you better hope you are with the right hospice.

The following posts will give you tips on what to find out about a hospice before signing up. Tip number one is that you need to find these things out before you sign up. Every time I get a phone call about a possible admission my heart starts beating a little faster, because admissions are the lifeblood of any hospice company. At that moment I become a hospice salesman. I want your business and will do what I can to get it. If you ask me for something that is a little beyond the hospice norm during that initial phone conversation, I’ll probably say yes. If you ask for that a month after you sign up it will be much easier for me to tell you that hospice doesn’t usually do that kind of thing. Once you have signed on and built relationships with my staff I assume that you are not going to leave us for another hospice. If you ask for something way out of the norm, I know you are not going to leave us if I say no because we have a history. If you ask for that before we start, I know it could be a make or break detail. If you are going to sign yourself or a loved one up for hospice, make sure you ask your questions and get your promises up front. That first phone call is important, and most all of the future posts are going to deal with things said during that one five minute call.

Follow the link to read part two of this series: Why ownership matters


Rod Ford

The author said, “If you ask me for something that is a little beyond the norm during that initial phone conversation, I’ll probably say yes. If you ask for that a month after you sign up it will be much easier for me to tell you that we don’t usually do that kind of thing.”

This is disturbing! Sounds linke you are selling death like a used car. And quite frankly it makes me sick.

Making a decision to place someone into a hospice program is NOT like buying a used car. Your dishonesty in the sales cycle makes me angry and causes me great concern as we consider hospice for my father.


And Rod, this is why it is important for the consumer to know that they can change hospices at any time. I work in hospice and I find that disturbing as well.

Hospice Guy

Rod and Anonymous, I can see how you took my words wrong. I never meant to say that I hold back services that people need. I’m sorry that it came off that way.

Let me try to give an example. Most hospices have protocols for how they treat a wound. You start with a more standard treatment and progress to more “aggressive” measures when your first measure didn’t work. Step 1 works for 75% patients and costs $20. Step 2 works for 99% of patients and costs $100. Your need to be financially responsible demands you to follow this protocol.

I have patients/families call and ask specifically about what we are going to do about the patient’s wound. If they are educated and request step #2 (for good reason), I may be willing to skip step #1. If nobody asks, then I start with step 1, because that’s the protocol. If step #1 doesn’t work, we progress until the wound is taken care of.

I know this is a very simplified example, but I hope it makes sense. I would never consider giving a patient less than what they need, but there is no doubt that educated patients and families who know what they want or need have the ability to prod hospices into using more aggressive measures than they usually do.

I have not and will not give people things above and beyond what a hospice should provide and I will never give a patient anything less. I’m not selling hospice like a used car; I’m only trying to do what I must to watch the bottom line while providing everything my patients need.

Hope that makes sense.


Thank you for writing this terrific series. This invaluable insider’s information will no doubt help countless people in their search for hospice care. Your site is such an important resource!

I’ve linked to the Hospice Blog and incorporated some of your suggestions for finding quality hospice care in a recent article for Please check it out, sometime!

Keep up the great work!