A hospice start feels like a single decision, but it runs as a chain of handoffs, and each handoff is a place where a call goes unanswered or a delivery arrives with nobody assigned to receive it. Walk the chain in order before the first visit, and you will know where to watch.
Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.
Before the first visit
The referral comes first, and the paperwork that starts the benefit follows, including the election statement that the patient or the patient's representative signs, and the physician's certification that the illness is terminal. You do not need to understand the medical wording to ask who has signed what, and when. Ask the hospice for the name of the admitting nurse, when the first visit is expected, and the number to call at night. Write those down before anything else happens. Federal rules set time limits on the first assessments, so ask the hospice to tell you how its schedule meets them.
The first visit
The nurse usually spends the first visit learning the house and the household. Expect questions about who lives there, who helps during the day and at night, what equipment is already in the home, and what your parent can and cannot reach. Ask the nurse to go through the plan of care in plain words, and ask which items the hospice supplies under the benefit and which supplier delivers them. Review the medication list with the nurse and with your parent's pharmacist. Medicine stays with the family, the doctor and the pharmacist, and the nurse can explain what the list means for the visits. If the aide schedule is discussed, get the days and hours in writing, including the days with no visit.
The first week
Most gaps appear in the first week, when a delivery shows up with nobody there to receive it, or a night call goes to voicemail. Confirm who signs for equipment, who is home when it arrives, and where it will be placed. Make one test call to the night line, so you know the number works and how long it takes to reach a person. Then write down who you reached and what they said.
After the first week
Ask at the start how the equipment is picked up later, and who calls for that. Ask how supply reorders are made and who checks what is running low. Keep a short list of open items, and bring it to each visit. The start-up process is finished when every item has an owner. For the first questions to bring to the hospice, see Start Here.