How do I choose a hospice provider?

Choosing a hospice depends on what services are available in your area, so it helps to compare providers before you decide.

Not all hospices provide the same services, and the medicines they cover will vary. For that reason, it is a good idea to ask each hospice exactly what they offer.

What every hospice should cover

Knowing the standard list makes the gaps easier to spot. The National Cancer Institute says hospice services generally include:

• Medical and nursing services
• Medical supplies and equipment
• Drugs for managing cancer-related symptoms and pain
• Short-term inpatient care
• Volunteers to give caregivers a break
• Counseling and spiritual care
• Social work services
• Grief counseling and support for the family

The team usually includes doctors, nurses, home health aides, and social workers. Clergy or other counselors and trained volunteers round it out.

Hospice care most often takes place at home. It can also be given in inpatient units, hospitals, and nursing homes.

Questions that actually separate one hospice from another

Every hospice will say yes to "do you provide nursing care." These questions get past that:

• Which medicines will you cover, and which would we pay for ourselves?
• Who comes to the house, how often, and for how long?
• Who answers the phone at 2 a.m., and is that a nurse or an answering service?
• How fast can someone get here in a crisis, at night and on weekends?
• Do you offer inpatient care if symptoms cannot be managed at home, and where?
• What respite is available so a caregiver can sleep or leave?
• What bereavement support do you provide, and for how long afterward?

The overnight question matters more than people expect. Most hospice crises happen when the office is closed.

Practical points about cost and switching

Under Medicare, covered services from an approved hospice come at no cost to you. There are two exceptions. You may pay up to $5 per prescription for pain and symptom medicines. And respite care costs 5% of the Medicare-approved amount.

Room and board is not covered if you live in a facility. Ask about that rather than assume.

If the fit turns out to be wrong, you are not stuck. Medicare lets you change hospice providers once during each benefit period.

Where to look

It can also help to talk with family and friends who have used hospice services, and to ask your health care team who they would suggest.

Some groups exist to help you find and compare hospices. One is the National Hospice and Palliative Care Organization, which runs a Find a Care Provider database. NCI also points to Medicare's care comparison tool and to the Hospice Foundation of America.

Start sooner than feels necessary

Because hospice can provide support for months, not just days, it is worth starting these conversations as soon as you decide hospice care may be right for you.

NCI takes this head-on. Many people wrongly believe hospice is only for the last days or weeks of life. Families who sign up late often wish they had called sooner. They spent the final weeks handling alone what a team could have carried.

Making the calls commits you to nothing. It just means you will have chosen, rather than settled for whoever could come on the worst day.