Two Hospices Can Admit Your Parent. Compare the First Week Before You Choose.

The hospital has raised hospice. More than one hospice serves the discharge address. You need to choose before your parent leaves.

Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.

Do not start with brochures. Start with the first week at home.

Give each hospice the same facts. State the discharge address, expected arrival time, equipment needed, medicines that must be available and the hours when no family member can be present. Then ask each hospice to describe what it will do, in order.

This comparison does not decide whether hospice is right for your parent. That decision belongs to your parent or authorized representative, with the clinicians involved. Medicare requires an election statement that identifies the chosen hospice and explains the palliative rather than curative nature of hospice care for the terminal illness and related conditions. Medicare also says care for those conditions generally must be provided or arranged by the chosen hospice. Read the election before anyone signs it. (Medicare, Hospice Care; 42 C.F.R. § 418.24.)

Day 0, still in the bed: compare an actual admission

Ask the discharge planner which hospices can serve the address. Confirm with each hospice that it is Medicare approved and licensed or certified to operate in Missouri. Missouri law defines hospice as a coordinated program providing palliative and supportive services in home and inpatient settings through an interdisciplinary team. Missouri DHSS oversees hospice certification and provides a complaint process. (Missouri Revised Statutes §§ 197.250 through 197.280; Missouri DHSS, Hospice Medicare and State Licensure.)

Call each hospice yourself. Ask for the person who can confirm an admission, not someone who can only accept a referral.

Use the same opening each time: “My parent may leave the hospital today. The discharge address is here. Tell me what happens between the referral and the first nurse visit.”

Write down the answers to these questions:

• Have you received the referral and hospital record?
• What still has to be signed or certified?
• Who decides whether you will accept the admission?
• When will a registered nurse complete the first assessment?
• Who will meet us at home if the nurse is not arriving with us?
• Which equipment and medicines must arrive before my parent?
• Who confirms that those deliveries occurred?
• What number do we call if the car reaches home and the plan is not ready?

Federal hospice rules allow an initial registered nurse assessment within 48 hours after the hospice election, unless the physician, patient or representative asks for it sooner. That is an outside limit, not a promised arrival time. Ask each hospice to state its plan for this admission. (42 C.F.R. § 418.54.)

If a hospice says “someone will call,” ask for the role of that person and the next deadline. Put the answer beside the agency name.

Compare what the hospice will provide with what the family must provide

Hospice is not automatically a person sitting in the house all day and night. Routine home hospice usually depends on family, friends or paid caregivers for much of the continuous presence. The Family Caregiver Alliance advises families to define the work clearly instead of treating “caregiver” as one undivided job.

Ask each hospice to mark who handles every first-week task:

• Nursing visits
• Hospice aide visits
• Medicine ordering and delivery
• Medical equipment and supply delivery
• Teaching the person who will give medicines or use equipment
• Social work support
• After-hours calls
• Urgent home visits
• Short-term inpatient care
• Respite arrangements
• Hours when someone must remain with your parent

Federal rules require hospice nursing, physician services and covered drugs to be routinely available around the clock. Other covered services must be available around the clock when reasonable and necessary for the patient and family. This does not promise that a nurse will remain in the home. Ask what “available” means in the provider’s actual call process. (42 C.F.R. § 418.100.)

MedlinePlus describes hospice as team-based care that can include clinicians, social workers, counselors, aides and volunteers. A list of disciplines does not tell you how often anyone will come. Ask each hospice which team members are planned for your parent, who schedules them and how you will know when the schedule changes.

Day 1, the car pulls in: test the arrival chain

Before the hospital transport begins, call the chosen hospice. Confirm the discharge address, the best entrance, the person waiting inside and the phone number the hospice should use.

Ask for three separate arrival times: equipment, medicines and the first clinician. “Today” is not enough. Ask what you should do if any part is late.

Federal rules make the hospice responsible for medical supplies, appliances, durable medical equipment and drugs related to palliation and management of the terminal illness and related conditions when they are included in the plan of care. The hospice may use outside pharmacies and equipment suppliers, but it remains responsible for the hospice plan. (42 C.F.R. § 418.106.)

Do not assume every medicine or item in the hospital room will be covered by hospice. Ask for the hospice’s written explanation of any condition, item, service or drug it considers unrelated to the terminal illness and related conditions. Medicare permits the patient or representative to request this election statement addendum. Signing to acknowledge receipt does not mean agreeing with the hospice’s determination. (Medicare, Hospice Care; 42 C.F.R. § 418.24.)

Keep the hospice number where every person in the house can see it. Medicare tells patients to contact the hospice before seeking hospital, ambulance or other care related to the terminal illness because the hospice generally must arrange that care.

Day 2 to Day 3, the first full days: compare the promise with the schedule

Put the written plan beside what has happened.

List each completed visit. Add the name and role of the person who came. List every missing delivery, unanswered question and task the family is performing because no one else was assigned.

Ask the hospice nurse to show you the current plan of care. Federal rules require the plan to identify the services needed, their scope and frequency, the medicines and treatments involved, and the medical supplies and appliances required. (42 C.F.R. § 418.56.)

Then ask:

• Which visits are scheduled next?
• Who changes the plan when needs change?
• Who can come to the home after hours?
• What information should we give the answering service?
• Where would short-term inpatient care occur if the hospice team determined it was needed?
• Which facility provides respite care under your arrangement?

Do not accept “we have inpatient care” as the full answer. Ask for the facility name, who authorizes the move, who arranges transportation and whom the family calls first. Federal rules require short-term inpatient care to be available for symptom management and respite through qualifying facilities. (42 C.F.R. § 418.108.)

Day 3 to Day 7, the week: judge the operating system

By the end of the week, you have evidence that was not available in the hallway. Look at the handoffs.

Did the intake person’s promises reach the nurse? Did the nurse’s orders reach the pharmacy and equipment supplier? Did the after-hours service have the current plan? Did staff tell you who would call back and when?

Bring gaps to the hospice supervisor in one short list. State what was expected, what happened and what answer you need. Ask for changes to be written into the plan.

If the hospice cannot meet the agreed plan, ask Medicare or the hospice how a provider change works before signing anything new. Medicare permits a beneficiary to change hospice providers within the rules for the applicable benefit period. A transfer should include records and a clear effective point so care does not depend on two agencies assuming the other is responsible. (Medicare, Hospice Care; 42 C.F.R. § 418.30.)

If your concern is about care or patient rights, use the hospice’s complaint process. You may also contact Missouri DHSS. Federal rules require a hospice to tell the patient or representative how to make complaints and prohibit retaliation for exercising patient rights. (42 C.F.R. § 418.52; Missouri DHSS, Hospice.)

The useful comparison is not which hospice sounds warmest on the phone. It is which one can put names, times and backup steps around your parent’s first week. The federal, state and consumer references used here are collected on the Sources page.