A Hospice With Integrity

Dear Barbara, our hospice needs some educational information to share with laymen on doctor determination for admission and how two doctors may not agree on a patient meeting criteria. Basically, how can one hospice find a patient appropriate and admit them, and another hospice not admit the same patient.

You ask a very important question about different hospices accepting and not accepting the same patient. With a large number of hospices operating in the same area the competition has become fierce. If one hospice refuses to take a patient the doctor just hangs up and calls another hospice until he finds one lenient enough to take the person on. It isn't the way service was intended but is what is happening throughout the country--to the determent of what the hospice philosophy originally intended.

How can you educate the public? Newspaper articles about hospice and the services it provides are good but don’t happen often. What you can do is make frequent community education presentations to Senior Centers, local civic organizations, and church groups. Make your presence known to the community so you aren’t just relying on physician referrals.

What are some resources to help physicians understand admission criteria? The National Hospice and Palliative Care Organization, The American Academy of Hospice and Palliative Medicine, and The National Association for Home Care and Hospice are organizations that may have literature to offer physicians and the community. However, I think doctors already know the guidelines for placing a person on the hospice program. Hospice Medicare has been around long enough that everyone working in the medical field knows hospice accepts people who are estimated to have six months or less to live and are not receiving treatment for their life threatening illness. It is that simple. All the rest . . . just details. It isn’t really about physician education. It is about knowing when to stop active treatment, when to say “I can’t fix you”, when to think about quality of living instead of quantity of breathing.

What can you as an agency do about agency competition for referrals? Keep your integrity. Be the best hospice you can possibly be, provide the highest quality of care with the most compassionate, caring staff your area has to offer. Build a reputation within the community not of how many patients you serve but what kind of compassionate, “we go the extra thousand percent for our patient”, care you provide. Build a reputation within the community that makes people want to be taken care of by YOUR hospice, not just any hospice.

Something more about... A Hospice With Integrity

Hospices all over the country use my 25 minute film, NEW RULES for End of Life Care to educate families about end of life and hospice. They show the film at Nursing Homes, Assisted Living Centers, Churches, Community Centers, Kiwanis meetings, etc. to say, when the time comes, THIS is how we will care for you. In other words, the film is used as a conversation starter and as a calling card to their hospice.

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I used to be a hospice nurse, I went out to do a readmission on a patient, she had come off service as she had improved. I walked in, she came walking out of her room, went to the kitchen got a glass out of the cabinet then used the ice/water in door Refridgerator, this was a dementia patient, i asked family what had changed since discharge, they told me nothing. I did not admit, the hospice I worked for agreed


Hi Shannon, thank you so much for the info on charging protocol. You’ve taught me something. Blessings! Barbara


Great comments. Very helpful.


I can think of a couple of situations in which a hospice could bill a patient directly. If the individual has a co-pay or deductible with their private insurance. Another situation could be if the hospice is out of network.
A hospice has 3 days to inform an individual if they are out of network or if there is a deductible and what the charges would be. If an individual chooses to stay on after those 3 days, then they would be responsible for the charges. If an individual comes off hospice before those 3 days, then hospices usually don’t charge for those 3 days.

Nancy Buckingham

My husband came home from the hospital and then rehab facility and in two weeks our home health suggested hospice. He was on hospice for 11 1/2 months. My brother was living with us and he helped me take care of my husband daily and nightly. I could not have done it without him. I quit work and so glad I did so I could spend all my time with him. We had been together for almost 30 years, he transitioned to Heaven May 14th, just 3 weeks ago. I miss him terribly, I am lost, I really did love taking care of him. We fell in love all over again and our love went to a level I did not know existed. It was a beautiful year, difficult, but beautiful. Thank you for all your info. Families need more info about hospice. Thank you again

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