Most families who keep a parent at home on hospice find that the bills they expected are not the ones that arrive. The large items, the bed, the oxygen, and the visits, are easy to name. The disposable supplies are harder. Briefs, underpads, gloves, wipes, and barrier cream come in cases, the cases empty faster than anyone expects, and nobody writes the count down.
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.
Count one week before you count the month
For seven days, keep a simple tally on the refrigerator or on the back of the shopping list. Each time someone opens a new glove box, a pack of underpads, or a container of wipes, make a mark. Note which items are used at night and which during the day. The night count often differs from the day count, and it is the one families forget. At the end of the week you will know how many of each item the bed actually uses, not how many the box says it holds. Divide by seven, and you have a daily number to plan from.
Ask the hospice what it supplies
Medicare's hospice coverage is built around the terminal illness. Under the federal hospice rule, the hospice is responsible for the items and services related to that illness, and what it provides is set out in the plan of care. Items that are not related to the terminal illness, or that the hospice does not consider necessary, may be yours to buy. The rule does not give you a list you can look up at home, so ask. Ask the hospice nurse or the hospice office, in writing if you can: which disposable supplies they will provide, what quantity, how often they are delivered, who places a reorder, and what happens when a delivery is late over a weekend. Keep the answer with the plan of care.
Find the gap between the box and the bed
When you have the weekly count and the hospice's answer, lay them side by side. The gap is what your household buys. Common gaps are items the hospice does not stock, items sent in a size that does not fit, and items sent in a quantity that runs out before the next delivery. The gap is not a failure. It is the part of the bill that belongs to the family, and it should be written down so that the next person in the house knows where each supply comes from.
Decide who reorders, and when
The cost rises fastest when nobody owns the reorder. A household that runs out on a Sunday night buys the same item at the nearest store, often in a smaller pack, often without the size that fits. Pick one person to reorder, set a reorder point, such as when the box is a third full, and keep the supplier's phone number in the same place as the hospice number. If a hired caregiver is in the home, that caregiver may pick up a supply order as an errand, and may check the count and note what is running low. The choice of product and size stays with the family and the hospice.
Compare by the day, not the case
When you compare prices, do not compare the price per box. Compare the price per day of use, using your own weekly count. A larger pack that the bed empties in four days can cost more over a month than a smaller pack that lasts two weeks, once you count how often you must make the trip to buy it. Then check three things: whether the supplier will ship on a standing order, whether it will substitute a different product when the item is out of stock, and whether an unopened case can be returned if the size is wrong. Those answers change the monthly total more than the sticker price does.
Keep the tally going for the first month. After that, a few minutes once a week is usually enough to keep the box from running out before the month does. The Sources page lists the Medicare and federal rules this guide rests on.