If you’ve made the decision to place a loved one in a hospice, you might be stymied over the options, and the choices involved.

According to research by the National Hospice Foundation (NHF), 80% of Americans wish to die at home, in actuality, less than 25% of people do. While hospice care offers compassion and dignity to the dying, NHF research shows that 83% of us know almost nothing about hospice care. Very simply, hospice involves a team approach to caring for someone with a terminal illness. It provides for their medical treatment (including palliative care, and at the end, adequate pain management), emotional and spiritual support.

Hospice services are not solely for the elderly. It can provide end-of-life care for patients of all ages with a range of illnesses. After a physician certifies that a patient has six months or less to live, he or she is eligible to receive hospice care for as long as needed─even if the patient lives longer than six months. Care is covered by most private insurers, Medicare and Medicaid.

Most of the time hospice care takes place in a patient’s home. The hospice care team typically includes the patient’s primary caregiver, their personal doctor, the hospice physician, nurses, home health aides, social workers, clergy or other spiritual counselors, trained volunteers, and (if needed) physical or occupational therapists. The team offers care and guidance, including respite time for the caregiver and bereavement counseling. If in-home hospice care isn’t feasible, consider a freestanding facility, or one that’s part of a nursing home or hospital.

Keep in mind the following points when choosing a hospice facility:

• Who’s on-call? Ask if the on-call nurse can get to the facility in 30 minutes or less. This is the person who will be called if your loved one needs emergency care at 3 am. You want help to arrive as soon as possible. Make sure they understand to call you as well.
   
• Look for accreditation. It’s voluntary, but it can be a useful tool in helping you decide. It means the hospice was willing to work with an independent organization to enhance their services, and meet quality standards. Accreditation is offered by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and the Community Health Accreditation Program (CHAP).
   
• Ask about pharmacy access. Does the pharmacy used have experience with, and thorough knowledge of typical hospice drugs?
   
• How many patients are onsite? Take a tour.
   
• Ask to speak to the administrator. If he or she can’t talk to you, then perhaps the hospice is too big. A caring place should take the time to talk to potential new patients and/or their caregivers, especially if you have an appointment.
   
• Ask how many case managers are on staff. A case manager is usually a nurse, and if he or she has more than 15 patients to care for, then the place is likely understaffed.
   
• Is it part of a chain? Chains are not bad, just make sure the branch you’re considering is focused as much on good, quality patient care as it is on profits or pleasing shareholders (if it’s a publicly traded company).
   
• Ask your healthcare provider, friends, family and neighbors for recommendations. You may be surprised how many people know a good place.

Take the time to develop a list of questions tailored to your specific circumstances. Write them down. Take this list with you on site visits or read from it when talking to hospice providers by phone. No doubt this is a difficult time and the less you have to memorize, the better.

To learn more about hospice and palliative care, visit the following web sites:

International Association for Hospice and Palliative Care

The American Academy of Pediatric Policy Statement on palliative care for children

The National Hospice and Palliative Care Organization