I've read a lot here from different posters about the pros and cons of various companies in the spectrum of home care. Now I'm at the point of finding a hospice company and would appreciate some input on experiences.

This could be an at home hospice or in facility situation. I've not decided at this point, and that decision will likely be based not only on the reputation and quality of the company, but on the level of in-home vs. in-facility care. Progression of the need for hospice care is also a factor.

First, some random questions on in-home care:

Are frequency of visits dependent on diagnosis?
Other than a hospice nurse, what other staff visited?
Did you find responses to be appropriate timewise, or were there delays in addressing needs?
What were the caliber of the home care and visitation staff?
Was a hospice doctor available for abrupt changes of health, or other urgent situations, recognizing that not all "emergencies" would be treated?
Were there any morale visits, such as by a harpist, other musician, or someone with pets?
Has anyone used hospice through the VA, and if so, what was your experience?

For in facility care:

Were there adequate staff?
Were the needs of the individual attended to, or was it sometimes "hit and miss" as it often is in hospitals or nursing homes?
What support, such as music and pet therapy, were available?
Were Skyping facilities available to communicate with out of town friends and family? If not were you allowed to bring in a laptop for Skyping?
Were there any activities planned?
Were visitors freely allowed depending on whether or not the patient had any communicable conditions?

Any other comments on the pros and cons of in home vs. in-facility?

Caveat: This is NOT a request for opinions on the morality of hospice care; it's not an opportunity for someone to start another tirade against hospice. It's a preliminary request to assist in choice between in-home and in-facility.

Second, if you have any great hospice companies to recommend, or conversely, some to avoid, please feel free to PM me as I'm doing as much background checks on any candidate companies as I can.

Thanks to everyone who offers advice.

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I started with research before it was needed and quickly whittled it down to about 3 places. When it was time, I called two of them. The first, Vitas, was rude and cold on the phone and I learned that they were a for profit entity. The second, the Connecticut Hospice, were patient and kind and gave clear answers to my questions. They are non-profit.

We had at home hospice. My mother's nurse came weekly but also whenever I called with a question or problem, he'd almost always stop by. She received CNA care every morning for two hours. We already had a hospital bed but they supplied a special undulating mattress and other equipment as needed. The social worker came frequently as well as if I called her for help.

My mother had medicare and medicaid. We received no bills ever.

They are fabulous as hospice providers, but kind of weak in the bereavement area. Nonetheless, the care for my mother and me as her primary family caregiver was gentle, compassionate, and full of understanding. I would have wished that the nurse could have gotten here earlier on the Saturday my mother died, but it probably would not have made a difference.
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Garden Artist....
As you know from my posts I had Hospice in for my Husband.
The Hospice I used is a Not for Profit Hospice.
When he was first on Hospice the CNA came 2 times a week and helped with bath and dressing, I did the other 5 days. Later, as he declined the CNA came 3 times a week.
The CNA ordered supplies, briefs, wipes, gloves, ointment and just about anything else I needed.
The Nurse came 1 time a week. She would order medications and DME if needed. Hospital bed first, then wheelchair then Sit to Stand and last a Hoyer Lift.
Medications were delivered the same day as they were ordered.
I also had a Social Worker on the team and she came 1 time a month.
A Chaplain was available if I needed.
All these people also worked with the VA so if there were medications that Hospice would not cover the VA would. If I needed supplies like wedges, draw sheet the VA supplied those.
And several times I had to use a Volunteer, they will come and sit with your Loved One while you run out to get a few things done, or go to a movie..what ever the reason someone will be there. This can be a one time thing or a weekly arranged visit.
I got support, encouragement and education from Hospice.  And this continued for 3 years.  As long as there is a documented decline a person can remain on Hospice.

If I had needed respite or if pain was such that it could not be controlled at home he would have been taken to one of the Hospices In Patient Units. Thankfully I did not have to use that.
Because I did not have to use Respite or In Patient Unit Care I do not know if the cost of In Patient care would have been covered by Medicare. I am guessing it would as Medicare would cover Hospital care if that were necessary.

My advise is to select at least 2 Hospice in your area and "interview" them just like you would interview a caregiver, a doctor, or anyone else you were to hire.

Tour the facility see what it is like just in case In Patient Care is needed.

Once you select the Hospice of your choice if at any time you have a problem with any of the staff CALL. You can find out if what is happening is standard or if an employee is just not doing their job correctly.
Going on Hospice is NOT written in stone. If you find it is not the "right fit" you can go off Hospice. Or you can contact another Hospice and switch.

Again I could not have done what I did with and for my Husband if it had not been for Hospice.
The CNA's, Nurses, Doctor's, Social Workers and Chaplains that all work in Hospice are doing a tough job, they are Angels.
And a slight plug for them..I live in Illinois, Northwest Suburbs and the Hospice I used was Journey Care. I can not sing their praises enough..
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GoldenArtist - start by finding out which Hospice your physician prefers to work with. Then they can do a lot to get it going.

Also, talk to people - they will tell you which one they are using and you can narrow the field. This is not the time for using the "Yellow Pages" to find someone. Our doctor recommended and started us with St Luke (HomeHealth & Hospice) and we've stayed with them for over 14 years now. First for my father and now for my husband.
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I have in home hospice for my mom. We chose a hospice organization that others I know have used. I don't know if different care is given based on diagnosis but I think so. My daughter's FIL had more services... He had pancreatic cancer. I feel it was appropriate as he was in extreme pain. My mom has stage 7 Alzheimer's. The hospice we use in a non profit located in Arizona. Mom gets a CNA twice a week to help with a bed bath. She is here about an hour. A nurse comes once a week and is here about 30 minutes. The social worker comes with the nurse about once a month. The doctor comes with the nurse about every 5-6 weeks. My mom has been on hospice for a year in one more week. I love our team.
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GardenArtist, I had Hospice for my Mom and for my Dad.

First was for my Mom who had been living in long-term-care. The Staff worked hand in hand with the Hospice Staff. A Hospice Nurse would visit once a week to check vitals. A bath person was assigned. Clergy was called in to visit. It was my understanding a volunteer would stop to visit. Due to my schedule I rarely saw Hospice, but I knew Mom was resting comfortably. The nurse at long-term-care gave Mom the requested medicine.

Second was for my Dad who had been living in Memory Care but was sent to the hospital due to aspiration. Dad was sent back to Memory Care with Hospice. Dad did rally for a day, but he did pass quickly due to aspiration pneumonia. Dad only had a couple days with Hospice.

Both times the Hospice group gave me a very informative 3-ring binder. Within the binder were sections: Your Care Team.... Comfort Management.... About Medications... Nutritional Information.... Personal Care... Infection Control and Safety.... Preparing for End of Life... Support for Caregivers and Love Ones... Your Rights and Responsibilities.... About the Hospice Services... Glossary.

The Hospice group I used is only located in the Washington DC location. Hope you can find a group where you live that you feel comfortable with.
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Hi GardenArtist,

We had hospice for my dad but he lasted less than a week so from that perspective I don't have much to offer. What I can offer is my professional perspective from having worked hospice for a private company for years.

Are frequency of visits dependent on diagnosis? No. While there is no hard and fast rule the family talks with the hospice company and together they come up with a schedule that's appropriate (but which is always subject to change). What the family needs is a big factor in deciding the number of visits.

Other than a hospice nurse, what other staff visited? A bath aide, a worker to set up a hospital bed (although they just come out the one time), and sometimes regular caregivers. Caregivers can give a bath but some families opt for a separate bath aide who comes and goes.

Did you find responses to be appropriate timewise, or were there delays in addressing needs? Anytime I had to call the office with an issue it was addressed immediately with the exception of a prescription which might take a few hours.

What were the caliber of the home care and visitation staff? I'm not sure what you mean by "visitation staff" but there were times I received complaints from families about the home care. They usually regarded the home care being hesitant to roll or otherwise move the patient because the patient would be so fragile and in pain while being moved. The more experienced home care didn't have any problems with this.

Was a hospice doctor available for abrupt changes of health, or other urgent situations, recognizing that not all "emergencies" would be treated? In my experience, yes. Things can change rapidly and I don't recall a time where I had to wait and wait for different medication or antibiotics. Like I said earlier, maybe a few hours.

Were there any morale visits, such as by a harpist, other musician, or someone with pets? Yes, we offered singers who sang songs that were popular when the patient was younger; we had a guy with a ukelele come out and sing as well. We never did pet visits that I can recall; we also had a chaplain.

Has anyone used hospice through the VA, and if so, what was your experience? I'm not familiar with VA hospice.

I'm sorry you're at this point, GardenArtist, but it's good to get your ducks in a row and be thinking about what you would like. Different in-home hospice companies offer different things aside from healthcare. One of my patients was an artist who sold his work. Our hospice had someone on staff who was also an artist so he came over with some of his work and the two got to talking about art. It was a wonderful visit.

I hope you find everything you need.
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If you choose in home, you may hear that 24/7 care is needed. I had 3 situations. First, hospice will include a certain number of visits such as daily to assist with personal care bathing or a nurse will come in to assess pain meds. 

One family member had the 24 hour care provided by 3 family members who took turns. This person was on I V morphine due to the nature of his pain. If pill form pain meds are needed in large numbers, be aware that prescriptions may only be written for small amounts and that someone may have to make weekly runs to the pharmacy.

The second person also required 24/ hr care  while remaining in independent living which I was responsible to arrange. I was still working and had to stay with her for 1 day until arrangements were completed. Fortunately she had her own funds. The home care (usually a PCA) is a separate arrangement to consider so you will have more than just a hospice arrangement to do. This is where you can ask about music, but music therapy may be a private pay add on for a specialist with experience.  

The 3rd person has hospice in a Medicaid nursing home (going on 3 years) with no other options. She is not responsive to facial recognition, and is no longer able to walk or speak. She is in a really good nursing home but we were lucky to get her in there due to a wait list.

Two people passed within a number of days. In home care came from 2 different resources as mentioned above.  Both people were not too aware of surroundings so music and wi fi were not needed. Visiting was much appreciated in the earlier stages but less so towards the end. Doctors were not necessary as APRNs could order meds. A hotline number was given for death. The nurse came in on a Sunday was able to fill out the death certificate.

Your choice of hospice will depend upon insurance. I may be wrong, but in facility hospice may have many restrictions.  Someone else will have to answer that. 

You can call around to see which option is the best fit as I am sure there are regional differences. You may want to call the 800 number on the insurance card to determine which hospices are geographically available and give you a great starting point.   I am glad that you are keeping one step ahead rather than wait at crisis time.
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