What should I be looking for when evaluating a Hospice care plan?

Nasmir - once deceased, the body must be removed ASAP. It cannot be allowed to linger on a floor while family figures out the wtf's on funeral & burial. Most hospitals have a mini morgue to hold if there's something that requires a body to remain. But otherwise, it needs to be transferred ASAP to a FH or crematorium.

Estatic..no way! At $ 155 a day R&B reinbursement rate, the NH isn't making $. If it only has Medicaid beds, it can't stay afloat. 24/7 care with all types of professional & support staff plus meals @ $ 155 a day = NO Profit. A Nh needs a mix of private pay, Medicare & Medicaid. $ 155 a day is a midrange hotel rate and there's no medical care.

$ 4500 a mo for hospice care is a bargain. It's basically $ 1,200 a week to pay for all professional, coordination of services, fronting of equipment leasing & be on call 24/7. Plus dealing with families.....For small hospice groups, I'd bet their profit margin is pretty narrow. If it was lucrative, there would be hospice vendors & MD doing hospice coming out of the woodwork. But I don't think that's the case especially for MDs. In 1998, about 3,200 and In 2008 there were about 4,000 Medicare certified hospices. Not much increase.

Now AL, imho that's the profit center as its almost always private pay or some mix of private, VA A&A or LTC insurance & done by contract. AL = Profit$

Hospice was a Lifesaver for our Mother and the family. It allowed our Mom to come home for the last 5 months of her life, all the while, supported by a fantastic team of Drs, Nurses, bath aids, nutritionists, home health aides, medical equipment, coordinated clergy from our parish, and mental health professionals who helped us all along the way. My Mom had had uterine cancer, she had had a radical hysterectomy, followed by 6-8 weeks of Radiation, and still the cancer was so aggressive, it had metastasized to her pelvic bones, eroding them away, and she was in extraordinary pain, requiring heavy duty IV Morphine. Having hospice allowed us to enjoy our Mom in my sisters home while they did the difficult work of keeping her near pain free, but comfortable being constantly around the family and friends. Having her home was still a lot of work, and thankfully we had six of us kids, all taking part in her care, and we worked together like a well oiled machine, with everyone participating on a schedule, even the 12 adult grandchildren. It was only in the final 8 days of our Mom's life, that the nurse said that it's time our Mom go to the Hospice Hospital, and in Seattle, there is a specific hospital that does this exclusively, and the care there was impecable. There were physical changes that she could see, that we her children were too emotionally distraught to see, and her guidance was spot on, as within 2 days, our Mom so obviously was shutting down, her organs were shutting down, she began to slip in and out of consciousness, and soon went into a coma like state, but in no time did she ever appear to be in pain, which was our biggest concern. We knew we were losing her, we just wanted her to go in peace, and after 6 days unconscious, she did. Each of us took turn sleeping the night in her room with her, ao that she would never be alone, and the very morning she passed away, she woke up, and was staring at my brother, but unable to speak. It was clear, she was saying her goodbyes, and this brother quickly got each of us on the phone so that we could tell her how much we Loved her, and to hold on, as we all rushed down to see her. Thankfully she was still semi awake, and we were able to say our last goodbyes once more. And like that she drifted off to forever sleep, and joined our Father in Heaven. The Hospice Nurses allowed us all the time we needed, then asked us to go and have cofee in their solarium, where we had a good family cry, and we called the mortuary to come pick her up. The Hospice team, removed all of the medical equipment from her room, her IV, and placed the most beautiful quilt over her with a gorgeous dove on it, that another family member had donated. It was all very peaceful and serene, and she looked beautiful. Once her body was taken away, we all took her flowers to our Fathers grave, and we saw the most unusual and most beautiful cloud formation in the sky as a clear sign, that our parents were together at last, as it was supposed to be, it was remarkable is all that I can say. I'll never get over how hospice treated our family, and their follow up was comforting too. I hope that everyone who needs hospice takes advantage of their services, they were wonderful to us!

Also I'd like to add for my moms 18 mos of hospice care, Medicare paid an average of $4,500 each month to the hospice group. Her room & board at the NH was paid by medicaid at TX preset R&B medicaid rate of about $ 155 a day - which is one of the lowest day rates in the US.

I have my husband on Hospice.
The CNA comes in now 3 times a week to bathe and help dress him and will help with breakfast. I do these alone the other 4 days a week.
The nurse comes in 1 time a week and checks vitals and orders medications.
There is a Social Worker that comes in 1 time a month
There is a Chaplain that is available if I should need or want.
All my supplies are provided through hospice. Gloves, briefs, under pads, wipes and ointments. If I choose to use another product I purchase that myself.
Any medication that is needed is provided by hospice, if it is "formulary" meaning it is needed as a result of his condition. If I need a product like Mirialax or a laxative I have to get that. If he needs an anti-fungal for athletes foot I have to get that as well.
I have a hoyer lift and a hospital bed a Broda Chair (kind of like a wheel chair but that is like saying a Cadillac is kind of like a car)

All I can say is call around to the various Hospice that are in your area and interview them. Call your Doctors office and ask if they have a recommendation for one in particular.

And the important thing...Once you go on Hospice if you do not like the particular Hospice you can change or you can choose to go off Hospice.

Most Hospice will strive to keep the patient in the home but if there is uncontrolled pain there are patient units, some are in hospitals some in Hospice owned buildings and the patient can be taken to the unit and pain controlled. Quite often the person will pass there sometimes they are able to return home. And while on Hospice you are able to use a respite care where the patient will be brought to the patient unit and they can stay there for a period of time to give you a break.

I can not say enough good things about the Hospice group that we are with. I have been so impressed with them that one of the days I do have a caregiver helping me I choose to volunteer a few hours working in the office.

Just call and do an interview just like you would for anyone that would come into the home to help you out.

Namir...Please do not paint all Hospice groups or hospitals with the same broad brush.
This is one of the reasons that I said to call several Hospice groups and interview them just like you would for any service.
Would you go to a new dentist and not ask how much a cleaning is? How billing is handled? What insurance they take?
Would you go to a new salon and ask for a cut and color and not ask how much it will cost?
The Hospice group that I/we are with is great. They will never turn away a patient if the patient can not afford to pay.
In most cases insurance will cover all the hospice costs as well as Medicare.
I do not know what hospice or hospital you dealt with but it does not sound like the end of the story. (as Paul Harvey used to say..."the rest of the story")
So again please do not scare people encourage education about a service. Far too many people can use Hospice and fail to, final days can be made much more comfortable at home rather than in a hospital.

Gma54, I agree with you. Having Hospice at my mom's final month at home was a blessing. They helped my father with many things. They were at the house every other day until the last week when someone came every day. Nicest, most professional people I have met in the medical field.

Find out whether the patient is eligible to live in a hospice facility or have home hospice services. Ask what provision they make if the patient has a medical emergency at night and whether you should call hospice or paramedics if the patient falls and whether hospice delivers hospice-related medications to the home or gives the caregiver a prescription to be filled. Also whether they provide a hospital bed, oxygen and other equipment when medically necessary. Ask how often a doctor will visit the patient and an aide will come to shower or bathe the patient.
In my husband's case, a doctor visited only to determine whether my husband had stabilized enough to be taken off hospice care. I felt threatened by this, but he remained on home hospice care until he was sent to a nursing home. Find out whether hospice will guide you through the nursing home application process if needed. In my case, because I'm in my 80s, the nurse and social worker visited weekly. At that time, we had only one hospice provider in our city. Now there are two.

If you are planning to make meaningful end-of-life choices,
rather than just waiting for death to come,
then you should ask about which medical methods of managing dying
are approved and used in that hospice program:

Nasmir: Please understand that Hospice is a wonderful thing for the caregiver. Do not post scary thoughts.

When a patient dies and the family has no arrangements, it means they don't accept the death. The hospital is required by law to immediately notify the county health department of an "unclaimed body". Immediately.