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Choosing A Hospice

We frequently are asked, “How do I choose a hospice agency?”

http://autumnjourneyhospice.com/images/aj-11.jpgVery simply, you choose a hospice agency in the same manner and with the same care that you would choose any product or service that will have a major influence on your life or the life of a loved one.

It is important to understand it is an individual’s absolute right to choose the hospice agency he or she wishes to use, according to regulations issued by Medicare, Medicaid and the State of Texas.  Except for a legal representative appointed in writing by the individual, no one can make that choice or in any way take that choice away from the individual who is considering hospice care.  Most private insurers follow this philosophy as well, although you should check with your insurer to understand the limits of your coverage.

You might want to consider the following ideas in your search for a hospice agency.

First:

Make a list of the hospice agencies in your area. 

Friends and associates can be valuable sources of information since they may have had personal experience with hospice agencies or know others who have.  Your physician and your church may also have information on local hospice agencies. 

The internet is a good source of information about hospice agencies, since most agencies have a website that describes both their operation and their philosophy of care.  Using an internet search engine like Google, simply type in the word, hospice, plus your city or county and state.  You will get a list of the hospices in your area and in most cases direct links to their websites. 

As you take your initial look at each website, you will have your first opportunity to get a sense of each agency’s philosophy of operation.  Ask yourself two questions. 

  • Are you getting style or substance? 
  • Does the website serve their interests or yours? 

Continuing with the internet, for Texas hospice you can go to http://facilityquality.dads.state.tx.us/qrs/public/qrs.do.  This wonderful website is maintained by the Texas Department of Aging and Disability Services (DADS).  You can use its search function to find hospices agencies by street address, zip code, area code, county or city.

In addition, it offers information to help you evaluate the quality of service providers, including hospice agencies, skilled nursing facilities (nursing homes) and residential care homes.  Note that you can review the facility ratings, consumer complaints and discrepancies State inspectors have recorded over the past several years for each facility or organization. 

You can also visit the National Hospice and Palliative Care Organization’s website.  On their search page you can use the search criteria of your choice to find NHPCO member hospice agencies in your area.  You do not have to be an NHPCO member or be signed in to use this search page.

Second:

All Medicare and State licensed hospice providers must, by regulation, provide exactly the same care services to each of their clients.  However, the manner in which the care and services are provided can vary widely.   You no doubt have experienced situations in your life where you received the same services from two different vendors and found that the quality of the services differed greatly……. generally speaking because one of the vendors cared more and their staffs took more pride in the quality of their work.

For this reason, once you have narrowed down your list of potential hospices with your research in the first step above, you should conduct a more detailed study to gain a better understanding of how each hospice actually provides its services……..in other words the personality, corporate culture and attitude of each hospice agency toward its clients, its services and the care it provides. 

To help you with this, we’re going to give you a brief list of questions to ask.  We will also describe what you should expect from a hospice agency so you can develop your own list of questions.

When you are ready to ask your questions, start by talking with the admissions coordinator at each of the hospice agencies you are considering.  In some agencies, the coordinator relies heavily on a script and a checklist so, if the coordinator can’t answer all of your questions to your satisfaction, ask to speak with the Director of Nursing or the Administrator. 

Questions you should consider asking include:

Are you state licensed and Medicare/Medicaid certified (if the client will be using the Medicare Part A benefits or Medicaid)? 

As mentioned above, all hospice agencies in Texas must be licensed by the state.  If an agency offers services to Medicare clients, the agency must also be certified by Medicare.  An agency must also be approved by the State to provide services to Medicaid clients.

Are you licensed to provide hospice care in my county?

Hospice agencies in Texas, as part of their license application, must declare the counties they serve and cannot serve other counties.  In our case, we serve our clients in Collin, Dallas and Denton counties in the North Texas area.

Can you provide references from caregivers or family members who have used your agency’s services?

Some hospices will suggest that the privacy provisions of the HIPAA Act prevent them from doing this.  Preferred hospices will be happy to provide this information, since they will have many families who have asked to be used as references for future clients.

Do you ever charge Medicare clients directly for any care, services, supplies, equipment, or prescription drugs that you provide?

Medicare allows hospice agencies to charge a 5% co-pay for each prescription provided to the client and for a type of care called respite care.  However, preferred hospices will not charge the client for these and we NEVER charge our Medicare clients for these co-pays or any other item or service we provide.  When talking with hospice agencies, always keep in the back of your mind the question, “Do their policies and approaches to care serve to benefit them or your loved one”?

Will my prescriptions, supplies and equipment be delivered to my home?  Will there be any charge for delivery?

Preferred hospices will include this service at no charge.  They will also provide home delivery for all prescriptions, medical supplies and medical equipment, including oxygen, at no charge.  Some agencies will expect you to go to the pharmacy to pick up medications.

Will we see the same team (the registered nurse case manager, social worker, chaplain and certified nursing assistant on each visit or will you be substituting other staff members? 

Preferred hospices will make every effort to ensure the same four team members make all visits to their assigned clients. 

It’s very important to us to develop an intimate knowledge and understanding of every aspect of our client’s life so that we are able to provide the best possible care and assistance.  That means we need to know everything we can about our client and his/her interactions with family members and other caregivers.

We can only do this properly by having the same small group make all visits.  With this consistency we will have a better opportunity to create a bond of trust and affection that allows us, quite literally in many cases, to become part of the family.  It also gives us access to the knowledge we need to provide the most appropriate and best possible care.

From the standpoint of our client’s health and wellbeing, consistency is paramount to ensure excellent care.  We keep detailed records of all visits.  However, if a different nurse makes the visit, he/she may miss something during a client assessment simply because he/she won’t have the intimate and complete knowledge of the client’s situation that the assigned RN case manager does.

We also believe it is important to minimize the number of new people we put in our clients’ lives to ensure we don’t cause unnecessary disruptions or create anxiety for them.

If I have questions or concerns that the RN Case Manager cannot answer, who is the agency point of contact (name and phone number) that I can talk to so I can resolve my concerns?

Preferred hospices will be happy to provide this information to you.  At Autumn Journey Hospice you will always have immediate access to our Director or Alternate Director of Clinical Services and our Administrator.

What should we do, if we are uncomfortable or unhappy with the care provided by one of your staff?

You should contact the Director/Alternate Director of Clinical Services or the Administrator immediately and express your concerns.  Sometimes poor communication can create concerns and sometimes there can be personality conflicts.  Whatever the reason for your concerns, preferred hospices will take any actions required to resolve them including, if necessary, the replacement of the staff member.  You are always in control regarding who comes to your home to provide care.

What should we do, if we are uncomfortable with or have lost confidence in the hospice agency we chose?

As above, you should contact the Director/Alternate Director of Clinical Services or the Administrator immediately and explain your concerns.  Preferred hospices will respond quickly to resolve your concerns, if possible.

If the hospice is not able to resolve your concerns to your satisfaction, then you should consider a transfer to another hospice.  Preferred hospices will assist you in your efforts to choose and transfer to a different hospice.  The transfer process is very easy and is explained later on this page.

What type and amount of care should I expect from a hospice agency?

We’re going to describe what we do.  In our mind these are the minimum acceptable standards for a hospice agency.  You may want to check with your other prospective hospices to see what they do.

  • Your initial call will be answered by a person and not by a menu-based, automated answering system that saves the hospice agency time, effort and money……at the expense of your time, effort and patience. 
  • We will explain every aspect of hospice care to you and answer all of your questions.
  • We will give you references when you ask for them.
  • Our registered nurse case managers will visit at least twice each week and more if necessary. 
  • All of our nurses are registered nurses.

  • Our registered nurses have an average of 27 years of clinical experience and 21 years of hospice experience.
  • Our licensed medical social workers will visit twice each month and more if necessary
    • All of our social workers have Masters Degrees in social work.
    • Our social workers average over 25 years of clinical experience and over 7 years of hospice experience.
       
  • Our chaplains will visit twice each month if you request their help and more if necessary.
    • Our Director of Chaplaincy Services has a Doctorate Degree in counseling as well as being an ordained minister.
    • Our chaplains average over 30 years of experience including over 7 years of hospice experience.

  • Our home health aides will visit three to six times each week depending on the needs of our clients.  All of our home health aides are registered as Certified Nursing Assistants.
  • We will deliver medications, medical equipment and medical supplies to your door at no charge, including free delivery.
  • If you wish, you may use our Medical Director (a Doctor of Internal Medicine) as your personal physician.  She will visit you when needed to save you the effort and hassle of traveling to a physician’s office.
  • We will have a registered nurse available to you on a 24/7/365 basis to assist you with any problems you encounter.
  • We will provide care to you wherever you live.  This includes your home, an independent living facility, an assisted living facility, a group home (residential assisted living home) and nursing homes.

Third:

After you choose a hospice agency, it is very important that you monitor the services provided by the agency to ensure that the client continues to receive the highest level of respectful, compassionate and quality care that he or she deserves.  Never hesitate to ask questions of any staff member or, if necessary, the hospice’s Director of Nursing or Administrator when something is not clear to you or you have concerns about client care.  Preferred hospices will always provide prompt, courteous answers to your questions.

Finally:

An important concept to understand about hospice is that you are NEVER required or forced to remain with the first hospice agency you choose.  If for some reason you decide that your choice of hospice agencies is no longer in your best interests, you may transfer AT ANY TIME to another hospice agency without loss of Medicare Hospice Benefits.

Here is the Medicare regulation regarding transfers.  A Medicare hospice client has the right to transfer from one hospice agency to another once during EACH benefit period without loss of any Medicare Hospice Benefit.  Should a client decide to transfer a second time during a benefit period, he or she would forfeit the remainder of the current benefit period.  

However, since the Medicare Hospice Benefit consists of two ninety day benefit periods followed by an unlimited number of 60-day benefit periods, you can never use up your Medicare Hospice Benefit due to transfers.

The transfer process is very simple, requiring only that you or your legal representative write a one sentence letter to each hospice agency. The letter need only indicate that the transfer is taking place and the date of the transfer.  There is no requirement to provide a reason or any type of justification.  The letter to the previous agency should also contain a request that your records be transferred to the new hospice agency. Most agencies have transfer forms available that make the process even easier. The two agencies will then coordinate to ensure that the transfer is completed smoothly and safely.

 

Autumn Journey Hospice
5347 Spring Valley Road
Dallas, TX 75254
Phone: 972.233.0525
Email: wecare@autumnjourneyhospice.com