how to choose hospice why

Monday, June 30, 2008

How To Choose a Hospice: Why Recommendations Matter

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

There is little better than the recommendation from someone who has experience with a specific hospice. If you have friends that have used hospice in the past, you should talk to them. Be warned though that hospice is overwhelmingly popular with families who have used it, so one glowing recommendation doesn’t mean you have found the best hospice. Again, most hospices are good at caring for the average patient, so if your friend’s loved one was an average patient, you should expect a positive review. Ask your friend the questions from the other posts and see what you learn.

If your loved one lives in a nursing home, I’m going to assume that you have followed the instructions from part 2 that says that you should under no circumstances use a hospice that is owned by the nursing home or owned by the same person who owns the nursing home the patient lives in.

Assuming that is true, then here is some advice specifically for people looking for a hospice to come into a nursing home:

1. Ask the nursing home staff who they recommend. Usually they will have one that they use more than others or one that they think is best. The downside to this is that you have to make sure that the staff member you are talking to doesn’t moonlight for the hospice they are recommending. It is common practice for a hospice to hire a nurse from the nursing home to do some part time work. Obviously, someone on the payroll of a hospice isn’t an objective observer of which hospices are good and which are not.

2. Ask the nursing home staff if they can tell you the name of the best nurse from the hospice. Once you have that name, you can ask specifically to have that nurse Case Manage your loved one. This will help you avoid getting the rookie or the slacker. If you tell the hospice up front that it is important to you that you have a specific member of the staff, they will grant the request if it is at all possible. Remember, they want your business.

Notice in number one that I said the staff will either have one they like or one they think is best. Those two things don’t always go hand in hand. Nursing homes often judge hospices by how much of their work they can push off on the hospice employees. Hospices that hold their ground and make the nursing home do their job are not always popular with the nursing home staff, but they are often good.

Ask more than one staff member at the nursing home and ask people on different shifts. The night nurse will know if the hospice on-call nurse comes quickly, while the morning nurse will know if the hospice Aide shows up on time and does the job well. Ask around and see what you find out. It may not be the best or most objective advice you ever get, but you’ll learn a thing or two about your options.



All to often I see nursing homes prefer certain hospice agencies not because of the quality of care delivered but because of special incentives or perks that the hospice agency offers them. I worked for a national for-profit hospice for several years that would find admit patients to inpatient level of care unnecessarily just so the nursing home could get more money. It’s this kind of back scratching that makes me warn families to be wary of nursing home recommendations.


My dad's hospice was recommended by the nursing home he's in and I was skeptical, but they sold them to me by pointing out that the LPN is in the building 8-9 hours / 5 days a week and available to us, should we have questions or concerns. Now, 2 months later, I've learned that there is an "arrangement" between the two. The hospice pays the SNF and the SNF now provides whatever is needed for hospice care. It makes me uneasy. Is is legal for the hospice organization to pay the SNF? Doesn't seem right to me? Does Medicare allow it?