Some more hospice questions

MN Chickadee

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jfkoc

It is my understanding that they all must provide certain services and those are reimbursed by Medicare.

They will differ in personalities and what they choose to offer additionally. I would get those extras in writing.

I fired our first Hospice and found the second to be far superior. So much depends on staff.

terei

My experience with 2  hospices in MN was overall excellent.  

Don’t overthink the decision.  Both of their active dying were very similar.  No, IME there will not be constant hospice attendance at the end.  They may visit daily at that point, but maybe not. I was with my LOs at the end 24/7 for 30 days for one + the last week for my mom. ONe reason they are not in attendance is because it is impossible for them to say with certainty when the end will come.  I expected both my LOs would go ‘that day’ for 3-4 days.   They were very responsive when I called(it was always a callback within a couple hours)  The facility did their normal jobs, changing them, freshening sheets, etc.

Keep in mind, if the hospice isn’t working out for you, you can call in a different one(confirm that with the hospice you choose)

My mom was at a MC at the end + I stayed there her last week. Hospice was there in one form or another 3-4 times a week for about 6 months.  Bathing, music, massaging her legs, feet, etc just visiting with her. Supplying equipment + all meds.  I’m not sure what you mean by ‘incident’.   Usually there is a DNR + they cannot be transported to a hospital while under hospice care.

One thing I learned after the fact was that I could have been giving her her meds(morphine, etc (I didn’t know it was allowed) + was waiting for the MC staff to do it, which sometimes took longer than I wanted.  

They collected info from me such as death arrangements so when I called them + said LO died, they called the coroner, funeral home(in our case, cremation services) + arranged pickup etc + that was very helpful at such an emotional time.

I honestly have not heard of a ‘bad’ hospice in MN.  All the people I had contact with were helpful + empathic. They offered bereavement services that we did not accept + followed up after death also.

NizhoniGrrl

I've had very good hospice experiences, but none of them stayed during the active-dying phase. They were very responsive when we needed help, especially when it came to adjusting meds to deal with my brother's increasing agitation. His last two nights we ended hiring a night nurse out of pocket, simply because I was starting to break down from lack of sleep and he would struggle to get out of bed during the night (which was very dangerous since he was so weak, he would have fallen, and we needed help changing his diapers at that point - even emaciated he was heavy). It wasn't easy, but it was better because there was always someone to call to ask questions and to come by if I needed help with something. My brother was only on hospice two weeks, so someone came by daily for one thing or another (an aide for bathing, a nurse to check his portable PICC line, etc., medication delivery). There was even a social worker who called after he died to see how I was doing. Don't overthink the choice. Pick one and you'll know pretty quickly if it is a good fit.

Cynbar

All hospices are paid the same daily rate, per patient, by Medicare or other insurance. It is the same for all patients and it is paid for every day the patient is on hospice, even if they don't get any visits that day. They then have some latitude in how they spend that money. Yes, there are certain things they have to provide, such as nursing visits and medical equipment, but they can vary a great deal in how much of those they will provide. Some cover more medical equipment such as a power lift chair and Broda chair, some cover incontinence supplies, some offer more auxiliary therapies such as music therapy. In my Experience, no hospice is generous in all areas, they couldn't afford it, so you have to decide which are more important to you. Then ask each one you are interviewing. Do they have a triage nurse available by phone to advise in off hours, and do they have nursing staff who can make an off hours visit if necessary? How many social workers and chaplains do they employ? Can they do daily nursing and/or home health aide visits if needed? Is it possible to get aides twice a day? Again, ask about the areas that are most important to you. They don't provide continuous nursing at end of life (except occasionally in very rare circumstances) but they should come daily at that point., And, as mentioned above, you can always change hospices if the first one doesn't work out.  You can be scrupulous in asking all the right questions, but you won't know for sure until you are in it.

King Boo

A parameter to consider is whether there is a 'flow' to an inpatient hospice facility in case of need (generally, symptoms that cannot be adequately managed at her current facility)  We were fortunate, because we had an inpatient hospice wing at our facility.  It is generally only utilized in the very final days of life - but the advantage is the care staff are all hospice nurses and have that 'third eye' of a hospice nurse, which regular care staff lack.

However, it is not always an option.  Just tossing that out there to help with decision making. 

I would beware calling random hospice agencies.   The monthly fee Medicare pays is hefty (over 5000/month) and thus some fly by nighters have popped up.

Asking at the facility, and perhaps contacts at another facilty, or your elder law attorney, who has provided excellent care goes a long way.  If a good agency regularly provides care at your facility, the path is already partially paved as staff know each other - a newbie coming in, not so much.

jfkoc

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice