how to choose hospice why some things

Thursday, March 17, 2005

How to choose a hospice: Why some things don’t matter

(This is the final part of a series on how to choose a hospice. To start from the beginning 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, but some are silly, some are downright self serving, and many are available to anyone who can fill out an application and write a check. Here’s my list of what is and is not important:

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 conference. Bear that expense for the sake of making their employees better is a sign that the organization is dedicated to patient 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 (programs that only provide hoops to jump through that often don’t have much to do with ensuring quality patient 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 to be a part of. Any hospice that has signed the Quality Pledge and is actually participating in the program is probably a good choice as your hospice. 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.

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.



I really enjoyed this whole series. Thank you for taking the time.


I am a hospice nurse turned Marketer very recently. I really enjoyed this series and will apply it in my everyday actions. Thank You for all the tips.


What If This Could All Happen Automatically,
with a simple push of a button…..


Gee, this was all very interesting to me. I have been a nurse for 25 years and have never worked in Hospice. I have applied for position as a Marketer and have my second interview tomorrow. Tonight? I’m doing my homework. I need to know what makes a hospice “special”. I need to know if the company I am applying to fits the needs of it’s patients. This article helped me tremendously. I have a whole new perspective and can’t wait for my interview tomorrow! Thanks a lot.


Excellent advice… I have just one small bone to pick.
Certification for nurses is more than just letters after a name. It does represent a skill set and level of knowledge related to hospice and palliative care. In most cases, I believe, by pursuing certification a nurse also demonstrates a commitment to and interest in the specialty.

Having said all that, can you guess that I am an RN, CHPN?


Excellent series; sound advice!


Excellent series, thank you. My one comment is that in my area there is one non-Medicare certified residential hospice that I would take anybody to, and recommend it over all the others.


You make many good points in you blog.
I do agree however with the comment that certification is not just letters after a name. It does certify that that nurse has the basic knowledge necessary to care for hospice patients using best practices.
As a director of clinical services for a mid size hospice i know that it takes time, hard work, and dedication to pass the certification exam. The very best nurse in an ICU that chooses to come to work in hospice is a hospice novice and has a ways to go before becomming an expert. The nurses in my organization that have chosen to take the certification exam and passed are indeed the very best hospice nurses we have.

One other point. I agree with the continuity of care, having the same nurse caring for the patient throughout their hospice stay whenever possible. The RN Case Manageris the ideal model.
That said,we have such a nursing shortage in our region that we have hired a few full time LPN’s. Some of our RN case manager’s are teamed up with an LPN. They both work with the same caseload,they both get to know the patient and family and can provide that continuity as a team. They must be in very close communication at all times.
There are some exceptions based on patient/family needs where the RN only manages the patients needs. A nurse visits all of our patients 2-3 times a week. We also utilize the LPN’s when we need continuous care for a patient.
This has really helped our staffing greatly, and actually provided better continuity as our staffing is more stabelized. Hospice is a great job for the right LPN, and with extensive training and team work the LPN is a great assett to the hospice.
I do believe the RN/LPN team requires a limited and measured approach. By the way, there is a hospice and palliative certification for LPN’s as well as for RN’s
Thanks for the opportunity to respond. Keep up the good work!



Your series is incredibly helpful. My father was just diagnosed with advanced liver cancer and I need to make a decision very soon. Reading your series will make that decision more informed.


My father is in the last stages of COPD and it is time to seek hospice care. Discovering your blog at this critical time, before I begin calling the hospital’s referrals, has been a real godsend. “Knowledge is power!” Many thanks for your guidance.


what a great series. as a hospice RN case manager, i appreciate every attempt to educate the public about hospice.

i can’t agree with every point, but i wouldn’t choose this forum to argue about it because you’ve put forth such an impressive collection of thoughts for the layperson. for that, i am grateful.




I am knew to the hospice scene and still confused. My father has terminal prostrate cancer and has been living with my brothers family for 5 months. They can no longer care for him.

If you were to have a loved one at home how much does hospice actually do? Our problem is he has many bowel movements and this is taking up a lot of time, time that we don’t have because we work and have young children. Is this something hospice takes care of?

What about waiting lists? I heard do not let waiting lists scare you from a hospice, that you should still put your name in. Is this true?

I know in order to go into a nursing home you have to have very little assets. Is this true for hospice care too?

I could write a book on my questions alone!

Thank You.