Checklist for Evaluating Hospice Palliative Care Programs
Overview
Once you make the decision to seek hospice palliative care, make your search easier by using this checklist to find out about different programs. Add to it as you think of items that are important to you, and cross off those items that are not useful.
Make a copy of this checklist for each program that you plan to consider. Have the list in front of you as you ask questions of the hospice palliative care program staff, and make notes next to each item on your list.
Hospice Palliative Care Checklist
Name of hospice palliative care program:
Address:
City
Province or Territory
Zip
Phone number:
Where are services provided?
In your home
In a special inpatient hospice palliative care unit
In a facility (hospital or nursing home) where you are already a patient
What services are provided?
One or more doctors who can make home, hospital, or nursing home visits
Spiritual or religious counselling or advisors
Respiratory, occupational, and physiotherapists
Social workers
Home health aides
Shopping and errands
Meal preparation and nutritional counselling
Cleaning and household chores
Respite services if your primary caregiver becomes ill or needs a break
Prescription medications, and medical supplies and equipment
Interpreters or other special services related to your culture, ethnicity, or lifestyle
What is the plan of care?
Does the hospice palliative care program develop a care plan with you and your family?
Yes / No
The care plan should include specific duties, who will perform them and how often, and the name and phone number of the supervisor. A good program will develop a care plan by providing a health professional (not a clerk or administrative assistant) who will:
Talk with you and your family in your home (not just over the telephone).
Talk with your doctor or other health professionals.
Write down the care plan and give copies to everyone who will be involved in your care.
Who provides care?
Family members
Hospice palliative care staff
Your doctor
References
Get the names of doctors who refer patients to this program.
Identify families who have used this program. If possible, talk with the families. Ask about their experience and whether they would recommend the program to others.
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