How funeral homes build relationships with local hospices

What hospice teams need from a funeral home

Medicare requires a hospice to have nursing, physician services and drugs routinely available 24 hours a day, 7 days a week. Deaths at home happen at any hour, and the hospice nurse is often the one waiting with the family until the funeral home arrives. What helps that nurse most:

• A phone that a person answers, day and night, and a clear time estimate for arrival.
• Staff who arrive when they said, in a vehicle and with equipment suited to a home, stairs and narrow halls.
• A known release process: what the nurse needs to do before you take the person into your care, and what you need from the family.
• Gentle handling in front of the family, and a moment for the family to say goodbye.
• One named contact at your funeral home for questions, problems and feedback.

A hospice must also offer bereavement support to families for up to a year after a death. A funeral home that knows how that program works, and points families back to it, is easy to work with. See hospice bereavement programs.

Sources: [1], [2]

Practical ways to build the relationship

• Introduce yourself to the hospice's clinical manager or community liaison. Ask how its nurses prefer to reach a funeral home after a death, and share your after-hours number.
• Agree on a simple coordination sheet: contacts, after-hours process, release, personal effects and death certificate steps. Use our printable checklist.
• Offer short education sessions for hospice staff: what happens after a death, cremation basics, veterans' burial benefits, how to answer families' questions about arrangements. Do not promise continuing education credit unless the session is approved by a body that grants it.
• After a death the hospice handled well, call or write to say so. After one that went badly, talk it through privately.
• Pass on thank-you notes families write to the hospice team. See ways to thank a hospice team.
• Learn the hospice's bereavement program and memorial events, and ask whether you can help or attend.
• Know your market: which hospices serve your area, how many families each cares for, and who owns them. The hospice market tool shows this for free.

The rules on referrals

• Hospices are paid by Medicare. The federal Anti-Kickback Statute (42 U.S.C. 1320a-7b(b)) makes it a felony to knowingly and willfully offer, pay, solicit or receive any remuneration, in cash or in kind, to induce or reward referrals of items or services paid for by a federal health care program. The maximum is a $100,000 fine and 10 years in prison, and civil penalties and exclusion from Medicare can follow.
• The HHS Office of Inspector General (OIG) says remuneration includes anything of value, in any amount, and that the law covers any arrangement where one purpose is to induce referrals. It warns that gifts and entertainment for referral sources can violate the law if the intent is there.
• Funeral services are not paid by Medicare, so a funeral home is not buying Medicare referrals. But two things still apply. First, state funeral laws forbid buying funeral business: California, Florida, New York and Texas all bar paying or offering anything of value to get funeral business, and California also makes it a misdemeanor for anyone to accept such a payment. Second, anything that runs the other way, such as you recommending the hospice to families in return for its staff recommending you, looks like the swapped referrals OIG has named as suspect between hospices and nursing homes. OIG has not published guidance on funeral homes specifically.
• Families choose their own hospice under Medicare's rules, and they choose their own funeral home. Hospice staff should not steer them to you, and you should not ask them to.

OIG's guidance for hospices tells them not to give gifts or free services to patients, relatives or other referral sources to win referrals. A careful hospice will turn down anything that looks like a payment, and many have written gift policies. Ask before you give anything.

Sources: [3], [4], [5], [6], [7], [8], [9], [10], [11]

What a clean partnership looks like

• It is built on service, education and coordination, not on payments, gifts of value or promises of business.
• Nothing you give depends on how many families the hospice sends you, and nothing the hospice gets depends on how many patients you send it.
• Families hear that the choice of funeral home is theirs. If a hospice keeps a list of local funeral homes for families who ask, you are glad to be on it next to others.
• Anything beyond modest courtesy is written down, at fair market value, and reviewed by a lawyer who knows health care and your state's funeral law.

Sources: [4], [7], [11]