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Taking Care of Mom and Dad: Questions to Ask

The following is a list of questions you and your parents might ask when deciding on a hospice program.

Accreditation: Is the agency accredited by a nationally recognized accrediting body, such as the Joint Commission on Accreditation of Healthcare Organizations? This means that the hospice organization has voluntarily sought accreditation and is committed to providing quality care. The JCAHO is an independent, not-for-profit organization that evaluates and accredits health care organizations and is an important resource in selecting quality health care services.

Admissions: How flexible is the hospice in applying its policies to each patient or negotiating over differences? If the hospice imposes up front conditions that do not feel comfortable, that may be a sign that it's not a good fit. Also, if you're not certain whether you or your parent qualifies for hospice, or whether you even want the service, is the agency willing to make an assessment to help clarify these issues?

Certification: Is this hospice program Medicare certified? Medicare certified programs have met federal minimum requirements for patient care and management.

Consumer information: Does the agency have written statements outlining services, eligibility criteria, costs and payment procedures, employee job descriptions, malpractice and liability insurance?

Costs: How does the agency handle payment and billing? Get all financial arrangements -- costs, payment procedures and billing -- in writing. Be sure to keep a copy. What resources does the agency provide to help your mom or dad find financial assistance if needed? Are standard payment plan options available?

Family caregiver: Does the hospice require a designated family primary caregiver as a condition of admission? How much responsibility is expected of the family caregiver? What help can the hospice offer in coordinating and supplementing the family's efforts or filling in around job schedules, travel plans or other responsibilities? If your parent lives alone, what alternatives can the hospice suggest?

Inpatient care: What are the program's policies regarding inpatient care? Where is such care provided? What are the requirements for an inpatient admission? How long can patients stay? What happens if your mom or dad no longer needs inpatient care but cannot return home? Can you tour the inpatient unit or residential facility? What hospitals contract with the hospice for inpatient care? What kind of follow-up does the hospice provide for those patients? Do nursing homes contract with the hospice? Does the hospice provide as much nursing, social work and aide care for each patient in the nursing home as it does in the home setting?

Licensing: Is the program licensed, if required by your state?

Patient's rights and responsibilities: Does the agency explain these? Ask to see a copy of the agency's patient's rights and responsibilities information.

Personnel: If you're dealing with an agency, are there references on file? Ask how many references the agency requires (two or more should be required). Does the agency train, supervise and monitor its caregivers? Ask how often the agency sends a supervisor to your parent's home to review the care being given to the patient. Ask whether the caregivers are licensed and bonded.

Plan of care: Does the agency create a plan of care for each new patient? Is the plan carefully and professionally developed with you and your family? Is the plan of care written out and provided to all parties involved? Does it list specific duties, work hours/days, and the name and telephone number of the supervisor in charge. Is the care plan updated as the patient's needs change? Ask if you can review a sample care plan.

Preliminary evaluation: Does a nurse, social worker or therapist conduct a preliminary evaluation of the types of services needed in the patient's home? Is it conducted in the home, not on the telephone? Does it highlight what your mom or dad can do for him or herself? Does it include consultation with family physicians and/or other professionals already providing your mom or dad with health and social services? Are other members of the family consulted?

Questions: If you have questions or complaints, whom do you call? What is the procedure for resolving issues?

References: How many years has the agency been serving your community? Can the agency provide references from professionals, such as a hospital or community social workers, who have used this agency? Ask for specific names and telephone numbers. A good agency will provide these on request. Talk with these people about their experiences. Also check with the Better Business Bureau, local Consumer Bureau or the State Attorney General's office.

Services: How quickly can the hospice initiate services? What are its geographic service boundaries? Does the hospice offer specialized services such as rehabilitation therapists, pharmacists, dietitians or family counselors when these could improve the patient's comfort? Does the hospice provide medical equipment or other items that might enhance the patient's quality of life?

Telephone response: Does the agency have a 24-hour telephone number that you can call when you have questions? How does the hospice respond to the very first call? Do telephone staff convey an attitude of caring, patience and competence from the first contact, even if they need to return the patient's call? Do they speak in plain, understandable language, or do they use a lot of jargon about the requirements that your mom or dad must meet? What is the procedure for receiving and resolving complaints?

How a hospice responds to that first call for help may be a good indicator of the kind of care to expect.

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