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Letter on Choosing Hospice Care When the Time Comes

Inspired by the recent hospice articles and the latest Frontline,"Being Mortal", CHAP's Barbara Muntz decided to pen a letter to her four children about selecting her hospice care, when the time comes. She offered to share this letter in hopes of contributing to the conversation on speaking to your loved ones about hospice care.

These are the personal recommendations of Barbara Muntz and are not necessarily representative of all accredited organizations.

Dear ones,

As the time approaches for us to make choices about my healthcare, I realize that one of the decisions that you may have to face is whether or not I should be admitted to hospice care.

After working with countless anguished families through the years, I’d like to offer some guidance that might help you.

Let’s get one thing clear at the outset: Choosing hospice care is not a death sentence. It is, in fact, saying “Yes”to life in every possible way. If I have a life limiting condition, like cancer or Alzheimer’s or end stage heart failure, hospice can help all of us be together in the most important ways. Lots of folks I know say that hospice is a good thing, but just “not yet.” If you are wondering whether or not it is time for hospice care, my darlings…it probably is.

Choosing hospice is one thing, but choosing the right hospice is another matter entirely. There are some things that I want you to consider when selecting a hospice to provide my care. Here are some questions to ask:

Are you accredited by a nationally recognized accrediting organization?

  • Accreditation is not a guarantee, but hospices that seek accreditation are inspected more thoroughly, and usually more often, than those that do not.
How long have you maintained your accreditation?

  • Hospices that have maintained their standing through multiple cycles of accreditation show that they have sustained the kind of quality needed to provide a high level of care. Many hospices go through one accreditation survey, then do not maintain the requirements over time.
  • Look for a hospice that has been through at least two (three year) cycles of accreditation, or even better, three or more cycles.
What has your average daily census been for the last 12 months?

  • You would never have brain surgery at a hospital that only does 5 brain surgeries a year, right? Of course not - you would go to a hospital that does a ton of brain surgeries and does them well. The same principle applies in hospice. The more patients with my diagnoses that a hospice has seen in the last year, the more likely it is that the team has the expertise needed to ensure that I will get better symptom management and better care.
How do you manage care after hours?

  • The hospice should explain that they have a nurse on call and hospice team members can come to me 24/7. Ask them for their after hours call number. Then call it in the evening (Saturday nights are always good for this!) to see how long it takes to get a return call.
What is your model for providing continuous care?

  • Sometimes things get rough, and I may need round the clock care for a few days to manage symptoms or give you a bit of a break. Every hospice must provide this care if and when it is needed. Look for a hospice that has the staff available to do this. Ask if they have a prn pool or their own private duty staff to come when needed. Ask them to give you their average time to staff a continuous care case. This is a statistic that every good hospice should keep.

Life has taught me that the time to make these decisions is before we are forced to make them in haste. I never want you to have a single regret about choosing hospice care for me. Hopefully,this guidance will help.

Thank you, sweet ones, for caring for and about me. Love will sustain us, Mom

Barbara Muntz joined CHAP in early 2013. She is now in the role of  Senior Advisor. She is an experienced home care and hospice nurse who previously worked at Texas Health Resources (THR), a multi-hospital healthcare delivery system. More recently, Ms. Muntz served as Chief Nursing Officer for the Visiting Nurse Association of Texas. Ms. Muntz also served on the Board of Directors for the Texas Association of Home Care and Hospice. She holds a Bachelor of Science in Nursing and a Master of Theological Studies from Brite Divinity School. Barbara has four adult children.


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