Hospice service failures sadly do occur. Even just once is too often. Patients receiving hospice care and the loved ones that care for and support them are in a frightening place. Facing the end of life demands the highest and most reliable help. Fortunately, (most) insurances and CMS (Medicare) see the value of this care and cover the cost of hospice service. Patients deserve to have the promises of excellent care fulfilled by the competent and highly trained specialty staff that they employ.

Admission nurses set the tone for the Hospice vendor. If communication is not accurate from the hospice as well as the family at the time of admission, issues are bound to occur. Expectations of the patient and family must be heard and the hospice must explain accurately what can be provided. The staff that provides the care must be competent, highly trained and skilled in their assessments as well as capable of providing compassionate care. Staff that misses their appointments with the patients and do not call to reschedule are another source of service failure. Staffing shortages are all too common. Sadly, staff turnover has been higher than is optimal for most hospice agencies. Training new staff is expensive and time consuming. Hospice work is not for everyone either. It takes special people to provide this care.

The responsibility of hospice is across all disciplines, starts with the patient accepting the service and does not end at the passing of the patient but continues for one more year. Insurance and CMS require the team of hospice disciplines to meet every two weeks to discuss each patient on service. They are to review recent changes and discuss anticipated needs of the patient. The Bereavement staff is to follow the family for one year after the passing of the patient to assist and provide a resource for grief-related issues.

Leadership from Non-Medical Administration can be more crucial for the performance of the various disciplines that provide the service than the physician leadership. If the employee work environment for the field staff (aids, nurses, social workers, chaplains, APRN and physicians) is unfavorable, the effect on the staff will show with no shows, staff turnover and burnout. All this results in service failures by the hospice vendor.