Choosing hospice care for a loved one is a sensitive decision made during a period of profound change. This specialized care focuses on comfort and quality of life when a life-limiting illness no longer responds to curative treatment. Families often feel overwhelmed, making it difficult to know which questions to ask when evaluating providers. Asking detailed questions is the most effective way to ensure the hospice selected aligns with the patient’s needs and the family’s expectations. Understanding the support systems is fundamental to receiving appropriate care.
Questions About Financial Coverage and Eligibility
Hospice care is covered by multiple payors, but confirm the specifics of your coverage with the provider. The primary eligibility criterion for the Medicare Hospice Benefit is a prognosis of six months or less, certified by a physician, if the illness runs its normal course. Ask the hospice exactly what services are covered by Medicare, Medicaid, or your private insurance plan.
The Medicare benefit covers all care related to the terminal illness, including nursing, social services, and medications for symptom management. Clarify if there are any co-pays or deductibles, as Medicare typically only requires a nominal co-payment for prescription drugs and short-term inpatient respite care. If the patient lives longer than the initial six-month prognosis, they can continue receiving care through recertification. Recertification occurs after two 90-day periods, followed by an unlimited number of 60-day periods, provided the patient remains medically eligible.
Questions About Staffing and Daily Logistics
The hospice model relies on an interdisciplinary team, and families should understand who will be providing the care. The core team typically includes a Registered Nurse (RN), a hospice aide, a social worker, a spiritual counselor or chaplain, and the hospice physician. Families should ask how often routine visits are scheduled for the nurse and the aide, as this frequency is determined by the individualized plan of care. For routine home care, a patient typically receives four to five visits per week from the nurse and aide combined.
Confirm the hospice’s availability outside of routine visits, especially for urgent needs. The hospice must be available 24 hours a day, seven days a week for calls. Inquire who answers the phone—an RN who can provide clinical guidance, or an answering service that relays messages. Ask about the typical response time for a non-emergency call or a request for an unscheduled visit, as some hospices offer response times under two hours for urgent situations.
Questions About Medications and Emergency Care
A central part of hospice care is the management of pain and other physical symptoms, primarily accomplished through medication. Ask how comfort and pain medications are managed and supplied, as the hospice benefit covers all drugs related to the terminal diagnosis at no cost to the patient. The hospice should also have clear policies for the management and disposal of controlled medications in the home setting.
Inquire whether the hospice provides durable medical equipment (DME), such as hospital beds, oxygen equipment, or wheelchairs, and how quickly these items can be delivered upon admission. The hospice must have a clear protocol for when a crisis or sudden change in condition occurs, often initiating Continuous Home Care. This crisis care typically involves around-the-clock nursing for a short period to manage acute symptoms like intractable pain or severe respiratory distress. The goal is stabilizing the patient at home. Understand the hospice’s philosophy regarding hospitalization or returning to the emergency room, as the goal is generally to manage all symptoms at home to honor the patient’s preference for comfort-focused care.
Questions About Emotional and Bereavement Support
Hospice care extends beyond physical symptoms to address the emotional and spiritual well-being of both the patient and their caregivers. Ask what types of counseling or spiritual support are available for the patient during their illness, usually provided by a social worker and a chaplain or spiritual care coordinator. This support can include pre-loss counseling to help manage anticipatory grief and anxiety.
Clarify if volunteer services are offered and how they can be used, such as for companionship or to provide the primary caregiver with respite. Understand the bereavement services offered to the family after the patient passes away. These services often include individual counseling, support groups, and mailed literature. The Medicare benefit requires that bereavement support be offered for a minimum of 13 months following the patient’s death.