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When a Home Care Agency is providing Hospice Care:
- How many years has the agency been serving your community? What is their reputation in the community? Can the agency provide references from professionals, such as a nurses or community social workers who have used this agency?
- Is the agency Medicare and / or Medicaid Certified? Can they provide you with recent State Inspection results? These reports should be readily available upon request.
- If facility was cited for deficiencies, has the facility corrected any Quality of Care deficiencies in their State inspection report?
- Each state requires the residence to be licensed and/or certified. Does the facility have a current license/certification and is it displayed?
- Each state requires the administrator to be licensed / certified. Does she/he have current license/certification?
- Are all or most of care and services reimbursed through Medicare (Part A-Hospital) and those Medicaid eligible as this is customary? Are there any co-payment fees? Most private insurance reimburse for Hospice care but verify what portion they will cover.
- What other resources does the agency provide to help you find financial assistance if it is needed? Are standard payment plan options available?
- Does the agency have written statements describing services, eligibility criteria, costs, and payment procedures, employee job descriptions, malpractice, and liability insurance? Does handling of payment and billing seem reasonable?
- Is agency in good financial health? Does the facility follow generally accepted accounting procedures? Check with the Better Business Bureau, local Consumer Bureau, or the State Attorney General's office.
- Is the agency accredited by nationally recognized accrediting bodies, such as the JCAHO (Joint Commission on Accreditation of Healthcare Organizations) or CHAP (Community Health Accreditation Program) or other accreditation bodies?
- If you are not certain whether your loved one qualifies for hospice how flexible are they regarding an assessment to help clarify these issues or help you decide whether you even want Hospice care?
- Are there references on file for home care employees? Ask how many references the agency requires (two or more should be required.) Ask whether the caregivers are licensed and bonded as this is a national requirement?
- How quickly can the hospice initiate services and what are its specific geographic area is served? Check to see if patient changes locations that care will still be accessible.
- Does the agency train, supervise, and provide ongoing in-services for caregivers? Who makes supervisory visits and how often? Supervisory visits should be made by Nurses.
- Does the agency create a plan of care tailored to each patient's needs? Does the care-planning process include family, caregivers, and any other members of health team?
- Ask how often does agency send a nurse to the patient's home to review the care being given to the patient and actually updates care plan to fit patient changing needs?
- Is the plan of care written out with schedule of specific duties and work hours/days to be provided by agency?
- Does the hospice require a designated family primary caregiver as a requirement of admission and what responsibility is expected of the family caregiver?
- What additional help can the hospice provide to supplement the family caregivers regarding work schedules, child care obligations, travel, and other responsibilities?
- If the patient lives alone, what other options can the hospice suggest or offer? Are volunteer services available through the agency?
- What is the procedure for after hour emergencies? Is 24 hr on-call service available and will necessary home visits be made after hours?
- Who can you call with questions or complaints about a patient's care? What is the procedure for resolving issues?
- Does the hospice offer rehab services such as PT, OT, ST, dieticians, respiratory therapists, and social workers / grief counselors?
- Does the hospice provide medical equipment to enhance the patient's quality of life and help them maintain independence? Do they have access to any donated resources for supplies and equipment if financial resources limited or not covered by healthcare insurance?
When Hospice Care is In-Patient in a Facility
- Can you tour the inpatient unit or residential facility prior to admission? What is your first impression of facility's outward appearance? Is location convenient for family members to visit and is this encouraged? Hospice philosophy always values family involvement.
- What are the program's policies regarding when inpatient care is appropriate and where is such care provided? Is care provided in hospital, nursing home or hospice facility?
- What are the requirements for inpatient admission and if short-term care provided, how long can patients stay? In-patient Hospice care is usually provided on short-term basis.
- How and when is the initial needs assessment done? Is there an ongoing process for assessing a resident's need for services and how often are those needs evaluated?
- Is there a written plan of care for each resident describing available services and are residents and families involved in care planning process? What type of care regarding pain and symptom management is provided as is most common cause for inpatient care.
- What happens if the patient no longer needs inpatient care but not well enough to return home? Can Hospice care be resumed at home?
- Are physical, occupational, or speech therapy services available onsite or contracted out? Who coordinates these services and how are they billed to Medicare/Medicaid or other third party insurance?
- What hospitals and local nursing homes contract with the hospice for inpatient care? What kind of follow-up does the hospice provide for those patients?
- Does the hospice provide similar amount of nursing, social work, and nursing aide care for each patient in the nursing home as it does in the home setting?
- Are religious services held on the premises or arrangements made for nearby services?
- What percentage of the rooms/beds is available? Is there a waiting list? If so, how long do they estimate it will take to be admitted?
- Does a staff physician visit the resident regularly for medical checkups or can resident his/her have own personal physician?
- Are all or most of inpatient care and services reimbursed through Medicare (Part A-Hospital) and those Medicaid eligible as this is customary? Are there co-payment fees? Most private insurance reimburse for Hospice but verify what portion they will cover.
- Is a written contractual agreement available that clearly discloses healthcare, accommodations, personal care and supportive services, all fees, and admission and discharge policies? Does handling of payment and billing seem reasonable?