What to look for in a good hospice company

nutella, MSN, RN · Oct 8, 2016

I found that most people who come from hospital oncology or med/surg etc are disappointed as they seem to think that home hospice is "less work" or "less crazy". The biggest difference is the 1:1 meaning one patient/family at a time with less multitasking while you visit. Patient on hospice at home are often very sick and the acuity can be high depending on what is going on. You may see patients with pleurx to drain, CADD pumps, wounds, variety of symptoms and problems on a daily basis. A lot of teaching to family and patients, need to have excellent assessment skills, confident in clinical tasks, critical thinking as you also encounter emergencies of all kinds and decompensating families.

If you are looking into home hospice ("case manager") you want a company that:

- has a low turnover (otherwise the quality of the whole hospice care can be difficult to maintain) and experiences nurses

- has certified nurses and support specialty certification

- has dedicated staff for nights and weekend nights with less cross coverage through the case managers

- has an admission team (otherwise you get stuck with admissions on top of your caseload all the time)

- keeps your caseload within an ok number. I found that between 18 and 20 for ok but everything above 20 gets difficult especially if you have several pat in the active dying process because you will spend more time with those and will have to make daily visits.

- reimburses mileage with the federal rate

- company cell phone which you switch off when your shift is done

- uses CNA for all their hospice patients 5 - 7 days/week minimum 2 hours daily - otherwise you will get stuck with personal care in addition to your nursing duties

- has a structured orientation program

- has a supportive manager who understands that your productivity (the number of visits you have to perform per week) is what was agreed upon hiring - please make sure to talk about that! IMO 5 visits/day or 25/week are manageable if your driving distance is not crazy but if it is more than 5 /day it becomes a problem as documentation is excessive.

- is honest about their expectations. For example - if they expect you to do one admission per day you need to know because one admission home hospice is usually more of a several hour job because of the assessment and data entry/ documentation.There is nothing such as a "quick" admission because there are always problems and you need to do all the initial teaching, talk to the hospice MD and so on and forth

- pays you ok. While most home hospice agencies pay less per hour than hospital, they usually have a better amount of days off / time off and less weekend/night. Some even offer pensions now (again) as home hospice has become not so attractive anymore.

- has good support for nurses in the field.

You can ask your hospital case manager which hospice agencies they refer to and which they consider "successful" or "good", which can give you a first idea of what is out in your area. Next, when you look for positions sort out the ones who offer "sign on bonus" - that usually means revolving door in progress due to bad conditions and you do not want to start there. Pick the ones that are not "start ups" and more established. Apply and when you interview make sure to ask all of the above - most important is the productivity and the driving distance between patients. Shadow for at least 4 hours with a nurse.

deemarie · Oct 10, 2016

Wow thanks @Nutella,you couldn't have answered my question more carefully and thoroughly. I appreciate all of the info,and will take this into consideration in the near future

deemarie · Oct 11, 2016

Wow thanks @Nutella,you couldn't have answered my question more carefully and thoroughly. I appreciate all of the info,and will take this into consideration in the near future

danni12 · Oct 18, 2016

I agree with Nutella, I have been with a fairly large hospice company (200 patients) for about 5 years. I agree with making sure the hospice has a admissions team/nurse because it really ruins your day when you find out that you have to do an admission after seeing 5 patients, full time oncall staff because no one wants to work all day and then have to go out and work all night oncall too, manager who is flexible because that's why most people go to hospice is for the flexibility(able to go to kids school, events, start late or get off early when needed and appts with no hassle), and good, organized orientation. Hospice pays great, excellent time off (occasionally oncall maybe 1-2 times a month) and excellent benefits!

HisjuleRN · Nov 11, 2016

I found that most people who come from hospital oncology or med/surg etc are disappointed as they seem to think that home hospice is "less work" or "less crazy". The biggest difference is the 1:1 meaning one patient/family at a time with less multitasking while you visit. Patient on hospice at home are often very sick and the acuity can be high depending on what is going on. You may see patients with pleurx to drain, CADD pumps, wounds, variety of symptoms and problems on a daily basis. A lot of teaching to family and patients, need to have excellent assessment skills, confident in clinical tasks, critical thinking as you also encounter emergencies of all kinds and decompensating families.
If you are looking into home hospice ("case manager") you want a company that:
- has a low turnover (otherwise the quality of the whole hospice care can be difficult to maintain) and experiences nurses
- has certified nurses and support specialty certification
- has dedicated staff for nights and weekend nights with less cross coverage through the case managers
- has an admission team (otherwise you get stuck with admissions on top of your caseload all the time)
- keeps your caseload within an ok number. I found that between 18 and 20 for ok but everything above 20 gets difficult especially if you have several pat in the active dying process because you will spend more time with those and will have to make daily visits.
- reimburses mileage with the federal rate
- company cell phone which you switch off when your shift is done
- uses CNA for all their hospice patients 5 - 7 days/week minimum 2 hours daily - otherwise you will get stuck with personal care in addition to your nursing duties
- has a structured orientation program
- has a supportive manager who understands that your productivity (the number of visits you have to perform per week) is what was agreed upon hiring - please make sure to talk about that! IMO 5 visits/day or 25/week are manageable if your driving distance is not crazy but if it is more than 5 /day it becomes a problem as documentation is excessive.
- is honest about their expectations. For example - if they expect you to do one admission per day you need to know because one admission home hospice is usually more of a several hour job because of the assessment and data entry/ documentation.There is nothing such as a "quick" admission because there are always problems and you need to do all the initial teaching, talk to the hospice MD and so on and forth
- pays you ok. While most home hospice agencies pay less per hour than hospital, they usually have a better amount of days off / time off and less weekend/night. Some even offer pensions now (again) as home hospice has become not so attractive anymore.
- has good support for nurses in the field.
You can ask your hospital case manager which hospice agencies they refer to and which they consider "successful" or "good", which can give you a first idea of what is out in your area. Next, when you look for positions sort out the ones who offer "sign on bonus" - that usually means revolving door in progress due to bad conditions and you do not want to start there. Pick the ones that are not "start ups" and more established. Apply and when you interview make sure to ask all of the above - most important is the productivity and the driving distance between patients. Shadow for at least 4 hours with a nurse.

Wow, after reading this I feel even better about the Hospice Company I just hired on with....2 weeks company orientation with 6 weeks with a preceptor, issued cell phone and laptop, 12-15 caseload, generous PTO, we do have admissions nurses, we also have a weekend and on call night team, great team support, everyone loves what they do, flexibility with schedule, incentives for gaining

certifications ....I could go on and on raving about them. It is such a change from the previous place where I worked where most everyone was so burnt out and miserable. I am so blessed and thankful to be part of the family of Hospice.