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<div class="HwContainer HwElement" id="HwContainer"><a class="HwMainSkipNavigation" href="#HwContentTitle"><span class="HwAccessibilityText">Skip Navigation</span></a><div class="HwBlock" id="HwMain" role="main"><div class="HwRow"><div class="HwColumn" id="HwColumnSidebar1"><div class="HwCustom" id="HwCustomSidebar"> </div></div><div class="HwColumn" id="HwColumnContent"><div id="HwContentTop"> </div><div class="HwTypeFocus HwContentWrapper HwElement" role="article" id="HwContentWrapper"><div class="HwCustom" id="HwCustomContentTop"> </div><div class="HwContentHeader"><p><a name="top" id="Hwtop"><span class="HwAccessibilityText">Top of the page</span></a> </p></div><div class="HwContentTitle"><h1 id="HwContentTitle" tabindex="-1">Checklist for Evaluating Hospice Programs</h1></div><div class="HwContentTopNavigation"> </div><div class="HwContent"><div class="HwNavigationSection HwSectionSpecialSection" id="sec-aa114499-sec"><h2 class="HwSectionTitle" fingerprint="b4cb0a40" fingerprint-exact="e7c3d1bb">Overview</h2> <p fingerprint="dd58c1dd" fingerprint-exact="a1df1dee">Once you make the decision to seek hospice care, make your search easier by using this checklist to find out about different programs. Add to it as you think of items that are important to you, and cross off those items that are not useful. </p> <p fingerprint="0451d24a" fingerprint-exact="310fbc1e">Make a copy of this checklist for each program that you plan to consider. Have the list in front of you as you ask questions of the hospice program staff, and make notes next to each item on your list. </p> <table class="hw-preformatted hw-table-border GenericTableSpanPage" fingerprint="2433e18c" fingerprint-exact="59e4b8fd"> <caption>Hospice Care Checklist</caption> <colgroup> <col width="1%"> <col width="2%"> <col width="3%"> <col width="4%"> </colgroup> <tbody> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="4"> <p> <b>Name of hospice program:</b> </p> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top"> <p>Address: </p> </td> <td class="hw-align-text-left hw-align-text-top"> <p>City </p> </td> <td class="hw-align-text-left hw-align-text-top"> <p>State </p> </td> <td class="hw-align-text-left hw-align-text-top"> <p>Zip </p> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="4"> <p>Phone number: </p> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="4"> <p> <b>Where are services provided?</b> </p> </td> </tr> <tr> <td class="hw-align-text-right hw-align-text-top"> </td> <td class="hw-align-text-left hw-align-text-top" colspan="3"> <ul> <li>In your home </li> <li>In a special inpatient hospice unit </li> <li>In a facility (hospital or nursing home) where you are already a patient </li> </ul> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="4"> <p> <b>What services are provided?</b> </p> </td> </tr> <tr> <td class="hw-align-text-right hw-align-text-top"> </td> <td class="hw-align-text-left hw-align-text-top" colspan="3"> <ul> <li>One or more doctors who can make home, hospital, or nursing home visits </li> <li>Spiritual or religious counseling or advisors </li> <li>Respiratory, occupational, and physical therapists </li> <li>Social workers </li> <li>Home health aides </li> <li>Shopping and errands </li> <li>Meal preparation and nutritional counseling </li> <li>Cleaning and household chores </li> <li>Respite services if your primary caregiver becomes ill or needs a break </li> <li>Prescription medications, and medical supplies and equipment </li> <li>Interpreters or other special services related to your culture, ethnicity, or lifestyle </li> </ul> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="4"> <p> <b>What is the plan of care?</b> </p> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="3"> <p>Does the hospice program develop a care plan with you and your family? </p> </td> <td class="hw-align-text-left hw-align-text-top"> <p>Yes / No </p> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="4"> <p>The care plan should include specific duties, who will perform them and how often, and the name and phone number of the supervisor. A good program will develop a care plan by providing a health professional (not a clerk or administrative assistant) who will: </p> </td> </tr> <tr> <td class="hw-align-text-right hw-align-text-top"> </td> <td class="hw-align-text-left hw-align-text-top" colspan="3"> <ul> <li>Talk with you and your family in your home (not just over the telephone). </li> <li>Talk with your doctor or other health professionals. </li> <li>Write down the care plan and give copies to everyone who will be involved in your care. </li> </ul> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="4"> <p> <b>Who provides care?</b> </p> </td> </tr> <tr> <td class="hw-align-text-right hw-align-text-top"> </td> <td class="hw-align-text-left hw-align-text-top" colspan="3"> <ul> <li>Family members </li> <li>Hospice staff </li> <li>Your doctor </li> </ul> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="4"> <p> <b>Licensing and certification</b> </p> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top"> </td> <td class="hw-align-text-left hw-align-text-top" colspan="3"> <p>Is the plan: </p> <ul> <li>Medicare-certified? </li> <li>State-licensed? All state health departments certify hospice programs. </li> <li>Accredited by one or more professional organizations? These may include: <ul><li>Accreditation Commission for Home Care, Inc. </li><li>Community Health Accreditation Program. </li><li>Joint Commission on Accreditation of Healthcare Organizations (JCAHO). </li><li>National Committee for Quality Assurance (NCQA). </li></ul></li> </ul> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="3"> <p>Are the hospice nurses certified by the Hospice Nurses Association? </p> </td> <td class="hw-align-text-left hw-align-text-top"> <p>Yes / No </p> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="3"> <p>Are the hospice doctors certified by the American Board of Hospice and Palliative Medicine? </p> </td> <td class="hw-align-text-left hw-align-text-top"> <p>Yes / No </p> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="4"> <p> <b>References</b> </p> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="4"> <p>Get the names of doctors who refer patients to this program. </p> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="4"> <br> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="4"> <br> <br> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="4"> <p>Identify families who have used this program. If possible, talk with the families. Ask about their experience and whether they would recommend the program to others. </p> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="4"> <br> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="4"> <br> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="4"> <p> <b>After your visit</b> </p> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="3"> <p>Does this program provide the services you want? </p> </td> <td class="hw-align-text-left hw-align-text-top"> <p>Yes / No </p> </td> </tr> <tr> <td class="hw-align-text-left hw-align-text-top" colspan="3"> <p>Is this program covered by your insurance? </p> </td> <td class="hw-align-text-left hw-align-text-top"> <p>Yes / No </p> </td> </tr> </tbody> </table> </div><div class="HwNavigationSection HwSectionRelatedInformation" id="sec-aa114499-RelInfo"><h2 class="HwSectionTitle" fingerprint="d5f858e0" fingerprint-exact="c0ffe04b">Related 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