Most families meet the hospice team after the choice already feels made, or they meet one agency through a hospital discharge planner who has a short list and a deadline. If you are still comparing, you can ask the questions that show who actually comes to the house and who answers the phone when the house is quiet and something is wrong.
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.
Start with the phone you will call at night
Ask each agency for its after-hours number, then ask who answers it. The answer might be a nurse who knows your parent's chart, a triage service that takes a message, or a general line that routes to whoever is on duty. Ask whether that person can decide that a visit is needed, or whether they only record the call for the day team. Ask how a call that needs someone at the house is handled in the middle of the night, and whether the person who answered will be the one who follows up in the morning. Write down the name the agency gives you, not only the number.
Ask who decides the visit schedule
Hospice visits are set by the plan of care, which the team builds with the doctor and the family and reviews as things change. Ask each agency who writes the plan, how often the team meets to revisit it, and what happens between reviews when you need someone sooner. Ask for the names of the nurse who would coordinate, the social worker, and the chaplain if you want one, and whether each is employed by the agency or contracted. A contracted person may not be reached on the same line as the rest of the team, so ask for the number you would actually dial.
Ask what a same-day visit looks like
When a change happens on a weekday afternoon, ask how a visit is requested, who approves it, and what the usual wait is in your area. Do not accept a single reassuring word for the answer. Ask them to describe the last time a family asked for an unscheduled visit and what happened next. Ask whether the process is written anywhere you can point to, such as the admission packet or the plan of care, or whether it lives in one employee's memory. A written process you can read back is worth more than a warm voice on the phone.
Ask what gets written down and shared
Ask how the family sees the notes. Ask whether you receive a copy of the plan of care, how you request it, and whether the aide's visit notes are shared with you. A team that writes things down and shares them gives you a record you can take to the next nurse or the doctor. A team that keeps its notes internal leaves you explaining the week from memory each time someone new walks in.
Compare the answers, not the brochure
Put the agencies side by side on one sheet with the same rows: the after-hours person, who decides on a visit, the same-day process, who writes the plan, and what is shared with you. If an agency would not answer a row, write that down as its answer. Then check what you were told against the agency's written materials and against the public description of the Medicare hospice benefit. The benefit sets what Medicare covers, and the agency sets how it delivers that care, so a sound comparison looks at both. The public sources behind this site are listed on the Sources page. Ask each agency to show you in writing where its rules on changing agencies are described, since those rules are set by Medicare and the agency should be able to point you to them.
What to bring back to the family
If two agencies answer the same way, your choice comes down to fit, the manner of the nurse you spoke with, and whether the people you will meet seem to know your parent by name. If they answer differently, you have found the question that matters most. Either way, share the sheet with the person who will be awake at night, because that is the person most likely to make the call. For help in west St. Louis County, see Local Help for Hospice Families, and for the wider picture of the weeks ahead, start with Start Here.