how to choose hospice why size matters

Monday, March 14, 2005

How to choose a hospice: Why size matters

(This is part six of a series on how to choose a hospice. To start from the beginning 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? I can’t give a number for this one. To find out if a hospice is too small you should 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 12-15 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 12 is a good number, but know that profits come when you get to 14 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 over staffed 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.

(After a bit more thought I’d add that you need to ask how many LPN’s they use. Many hospices use RN’s for the big tasks and LPNs for the everyday tasks. This is a sorry way to do it, but that’s a whole other post. For now, just make sure that you find out how many RN Case Managers the company has.)

There are three more parts to this series. Next: Why Staffing Matters



Please know that only RN’s can be case managers. It is the law.


I’d like to see that law. I’ve never heard that PCM’s have to be RN’s by law. It’s just that most are. If you can back that up with a site, please do.