Consumer guide to hospice
Click to explore
We have data on hospices in
BACK TO TOP
By Dan Keating and Shelly Tan, Updated: Dec. 18, 2014
Hospices vary widely in ways that can affect patient care.
The Washington Post has gathered data largely from government sources on more than 3,000 hospices that participate in Medicare, which pays for the vast majority of hospice care in this country. No single factor can predict the quality of a hospice’s care, and these figures do not offer a complete picture of any single hospice. But consumers can benefit from knowing how a hospice compares to others on these important measures.
Select a state below to explore its hospices or read on to learn more about a hospice's important traits.
In compiling the statistics for the guide, The Post sought expert opinion on what information, among that which could be gleaned from Medicare reports, would be useful for consumers.
The guide provides information about agencies around the country, including, among other things:
Here is some advice from experts about how to weigh all of this information.
Age and size: The experts generally favored hospices that are older and that serve more than a small number patients at a time. A hospice over say, 10 years old, has a track record as well as experience. Medium-sized and larger hospices may be better able to provide backup and more intense services, experts said.
Accreditation: To varying degrees, experts consulted by The Post favored hospices that have been accredited by outside groups. Hospices that have been accredited have opened themselves up to outside scrutiny. They also have faced inspections more often - once every three years.
Inspections: The guide shows how long a hospice has gone since the last government inspection. A long span since the last inspection doesn’t mean that the hospice has dodged the inspectors. The reason for long times between inspections is that the federal government, partly due to funding shortfalls, has had hospices inspected only once every six years or so. Recent legislation is supposed to make them more frequent, however. Finally, keep in mind that this data is current through 2013. If a hospice has had an inspection more recently, it may not show up here.
Live-discharge rate: This statistic shows how many people leave the hospice alive and several industry experts have suggested it is a good reflection of quality.
The reason live discharge rate is useful may seem a bit counter-intuitive. In some cases, of course, leaving hospice alive is a good thing - because it means survival. But experts say that a live discharge rate much over 25 percent might be viewed as a warning because it may mean that the hospice is discharging patients when they need more care or enrolling patients who aren’t near death.
Spending: The guide includes data on how much the hospice spends per patient on nurses, doctors and therapy.
Patients receiving home visit in last two days: For patients receiving routine hospice care at home, the hardest days for the patient and family are often the last days prior to death. This measures the proportion of those patients who received a skilled visit from a nurse or therapist in those last two days.
These numbers come directly from the reports that the hospices file with Medicare. The Medicare cost reports, however, are unaudited, and some experts expressed caution about relying too much on them.
Finally, the guide should probably just mark the beginning of the shopping process. Experts advised interviewing hospices about their services, too. A list of questions suggested by the American Hospice Foundation may be found here.
Click to explore
We have data on hospices in
BACK TO TOP
A quarter of hospices serve an average of less than 20 patients at a time, while the majority handled between 20 and 100. The rest serve very large numbers.
Three organizations provide accreditation for hospices, the Joint Commission, the Accreditation Commission for Health Care Inc. (ACHC) and the Community Health Accreditation Program (CHAP). Sixty percent of hospices are not accredited. But the rest have been inspected and judged by the criteria of the three organizations.
Years in Business
More than 40 percent of hospices have been in business for 13 years or more, although many have changed ownership over time. More than a quarter of hospices have been in business six years or less in the growing industry.
Hospice began as largely a charitable or non-profit service, but for-profit companies now run 70 percent of the facilities.
Patients whose pain or other symptoms have flared out of control are supposed to be able to get continuous nursing care at home or general inpatient care. But more than one-in-seven hospices have not provided patients with either of those services, according to records. A majority of hospices have provided the special care less than one percent of the time. But some hospices more regularly provide the crisis services.
Spending Per Day on Patient Care
Hospices report how much they spend on average per patient for each day of hospice care they provide. Some hospices report spending less than $100 per day, while others spend at least twice that much.
For more information on choosing a hospice, readers may check with this guide from the National Hospice and Palliative Care Organization.
The vast majority of the information presented is from Medicare cost reports and service provider listings, which are submitted to the government by the hospices themselves. Nevertheless, information is sometimes inaccurate. Some hospices affiliated with hospitals file different Medicare reports and are not included.
If your hospice is on the list and you'd like to supplement our data or if you'd like to share your experience with a hospice on this list, please get in touch using the form below:
* Please first indicate who you are
Please enter a valid provider number
SOURCE: Medicare, Community Health Accreditation Program, Accreditation Commission for Health Care Inc., and Healthcare Market Resources.