Most families who keep someone at home on hospice have a phone number written down somewhere. It is on the refrigerator, in a folder, or saved under a name in the phone. The number is real. The trouble is that a number on paper has never been tested, and most families learn whether it works for the first time at two in the morning, when the question is already in the room.
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.
How to tell the night line has not been tested
You may not have a problem yet, but you may already have some of the signs. Notice whether any of these are true. You do not know whether the after-hours number goes to a nurse, to an answering service that takes a message, or to a recording. You have never dialed it when nothing was wrong. In a past moment of worry you called the family doctor, a neighbor, or a relative first, because you were not sure the hospice number would be answered. You have stood in the hallway deciding whether a call was worth making. You cannot say which decisions the person on the other end is allowed to make.
None of these tells you what a change in your loved one means, and that is not the question at night. The question is who picks up, what they can do once they have picked up, and how long it takes.
What to ask before the night comes
Ask the hospice these questions in daylight, and write the answers on the same card as the number. Who answers after hours? Is it a nurse on call, a service that takes a message, or someone with authority over the plan of care? If it is a message service, how soon does the on-call nurse call back?
What happens if the first call back does not come? Is there a second number, a supervisor, or a stated time within which the nurse must call? Ask for the answer in writing if the hospice has it.
Does the line work from a cell phone, from the house phone, and when the power is out? If you rely on a cell phone and the signal in the sickroom is weak, you need to know that now.
Can the on-call person send a nurse or aide to the house at night, or is the night call handled by phone only? Ask what kinds of situations lead to a visit.
When a situation is unclear to you, what does the hospice ask you to do first? Ask whether that instruction is written in the plan you were given.
Test it once, on purpose
Call the after-hours number during the day, when nothing is urgent. Say that you are checking the process for a future night. Ask the question you would ask at two in the morning, and listen to the whole path: the greeting, the hold, the name of the person who answers, and the time it takes for them to say what happens next. Write down the name and the time. If the call takes more than a few minutes to reach a person who can act, you have learned something you need to know before it matters.
What the rules promise, and what they do not
Federal hospice rules require the hospice to have someone reachable around the clock. That is a floor. It does not say how quickly a call will be returned, whether the person can come to the house, or whether they will know your loved one's history. Those details belong to your hospice and to the people who staff its line, and they are worth asking about by name. The documents behind this guide are listed on the Sources page.
When the answer is slow
If the test call shows a slow path, you have not failed. You have found out the shape of the plan early. Write the slow step on the card next to the number, ask the hospice what it will do to shorten it, and tell the rest of the household the real order of calls. Do not let anyone assume the line works because the number is printed. For West County resources, check the Local Help page, and if you are new to this, the first questions are on Start Here.