General FAQs
Insurance carriers (including Medicare) require that we receive a doctor’s orders prior to providing services for clinical services and Hospice, however referrals are not needed for Meals on Wheels and other community services. You can see specific referral requirements for our programs by clicking here.
Please contact Care Coordination for more information.
To speak with one of our Care Coordination nurses:
call 603-352-2253 or 800-541-4145 or reach out through our contact us page.
You’ll speak in confidence with a member of our staff to discuss your situation and receive completely free, no-obligation information regarding our services and how we can help.
Home Healthcare, Hospice and Community Services is a local, not-for-profit organization. Many services are funded by Medicare, Medicaid, private insurance plans, donations, and grants. No one is denied the care necessary for their health and safety solely on the basis of ability to pay.
Home Healthcare, Hospice and Community Services is Medicare certified and licensed by the State of New Hampshire as a home care provider.
Determining what your family member, friend, or neighbor needs and how to pay for it can be a difficult undertaking. Our Care Coordination staff can answer your questions and discuss services that would be helpful. For a quick overview, you can also visit our “Make a Referral” page.
To speak with one of our Care Coordination nurses:
call 603-352-2253 or 800-541-4145 or reach out through the contact us page.
Care Coordination is available Monday through Friday from 8:00 am to 4:30 pm and weekends and holidays from 8:00 am to 4:00 pm.
You can also stop by our office in Keene for Walk-in Wednesdays, on the first Wednesday of every month, from 2:00-4:00pm. You’ll meet in confidence with a member of our staff to discuss your situation and receive completely free, no-obligation information regarding our services and how we can help.
Individual Program FAQs
- Behavioral Health
- Butterfly Release
- Foot Clinics
- Friendly Bus
- Hospice
- Medical Transportation
- Nursing
- Palliative Care
- Para Express
- Rehabilitation Therapies
- Transportation
- Visiting Nurses
- Wellness
Home Healthcare, Hospice & Community Services accepts Medicare, Medicaid, and many private insurances. Home Healthcare, Hospice & Community Services does not deny anyone the care necessary for their health and safety solely on the basis of ability to pay. If you do not have insurance coverage, you may be eligible for service at a reduced fee or free care.
Because everyone’s situation is different, there is no typical visit. We work with you and your doctor to design a treatment plan based on your specific situation. The VNA team members spend as much time as they need with every patient to make sure they are getting the care needed to get healthy again.
Your specific needs and your insurance coverage will help to determine how often VNA team members visit you. The total number of visits scheduled depends on your specific needs. VNA team members visit patients an average of two to three times a week. Visits will happen less often as you improve.
Home Health Care encompasses a wide range of health care services provided in the patient’s home with the purpose of maintaining a patient’s optimal level of health, well-being, and independence, according to their personal beliefs and choices. Home care is a collaborative effort involving caregivers, physicians, and an interdisciplinary home care team. It is a cost-effective alternative to extended hospitalization, rehabilitation, or a nursing home stay. Patients are usually more comfortable in their own home and studies have shown patients recover quicker at home.
In order to receive home health care services under Medicare, the patient must require:
- Skilled, intermittent nursing care, physical therapy, or speech therapy
- Have a physician’s order for home health care
- AND be homebound. Medicare considers a person to be homebound if leaving the home would require a considerable effort and if they have a condition due to an illness or injury which restricts the ability to leave home except with the aid of devices or assistance of another person. Homebound patients may leave their home if absences from the home are infrequent or for periods of relatively short duration.
During your first visit, the nurse or therapist will share a lot of information with you. They will also make sure the information we have about you is correct. The first visit may take up to two hours. The nurse or therapist will talk about:
- Your discharge paperwork and/or doctor’s orders
- Your role as a patient/caregiver, including payment responsibilities
- Your “Plan of Care,” including the services you will receive and how often team members will visit
- Your goals for home care
- Your medicines, including side effects and how and when to take them
- Your risk for falling
- How to contact the office with question or concerns
Because everyone’s situation is different, there is no typical visit. We work with you and your doctor to design a treatment plan based on your specific situation. The VNA team members spend as much time as they need with every patient to make sure they are getting the care needed to get healthy again.
Your specific needs and your insurance coverage will help to determine how often VNA team members visit you. The total number of visits scheduled depends on your specific needs. VNA team members visit patients an average of two to three times a week. Visits will happen less often as you improve.
A VNA team member will try to call you on the evening before to schedule a visit for the next day. However, sometimes they may not be able to call until the morning of the visit. We are sorry when we cannot offer more notice. We get new patients added to the schedule every day. Sometimes, they are very sick and require urgent visits. This causes our homecare team members’ schedules to change. They will always try to give you an estimated time when they will arrive. Please answer your phone or return our calls promptly.
We understand the importance of building trust with your caregiving team. That is why we try our best to schedule the same team of clinicians to visit your home every time. Changes in time of day, day of week, and after-hours may impact our ability to schedule the same nurse or therapist, so we cannot guarantee the same provider every time.
During your first visit, the nurse or therapist will share a lot of information with you. They will also make sure the information we have about you is correct. The first visit may take up to two hours. The nurse or therapist will talk about:
- Your discharge paperwork and/or doctor’s orders
- Your role as a patient/caregiver, including payment responsibilities
- Your “Plan of Care,” including the services you will receive and how often team members will visit
- Your goals for home care
- Your medicines, including side effects and how and when to take them
- Your risk for falling
- How to contact the office with question or concerns
If you or someone you know could use the expert skilled care provided by the VNA, please contact us by calling 603-352-2253 or 800-541-4145 or by emailing us at vna@hcsservices.org. Please do not email protected health information. You can also view our “Make a Referral” page to learn exactly what is needed for a complete referral to any of our programs.
For details about specific programs that HCS can offer, give us a call at 603-352-2253 or join us for Walk-in Wednesdays!
- Clients whose behavior poses a risk to self or others
- Clients who are actively using drugs/alcohol and are not engaged in substance abuse treatment
- Clients who are actively suicidal
When making a referral, please note that the client must be homebound or psychiatrically homebound. If a client is unable to consistently and independently access psychiatric follow-up, they may be considered homebound. The following behaviors and conditions demonstrate that the patient may be psychiatrically homebound:
- Impaired reality
- Disoriented
- Confused
- Impaired judgment
- Agoraphobic
- Depressed
- Anxious
- Uses assistive device (cane, walker)
- Limited endurance related to medical diagnosis
- Leaving home requires taxing effort
Admission Criteria:
- Client must have a primary psychiatric diagnosis, or a medical and psychiatric diagnosis
- Client must be under care of a physician
- Client must require the skills of a behavioral health nurse
Who should be referred for services?
- Newly diagnosed adults with a psychiatric diagnosis
- Clients on new psychotropic medication
- Clients who have difficulty connecting to traditional mental health services
- Clients who have issues with medication compliance
- Clients who have difficulty leaving their home
- Clients who are frequently hospitalized with psychiatric diagnosis
- Clients with depression, anxiety disorders, schizophrenia, bipolar disorders, dementia, or Alzheimer’s disease
The Behavioral Health Home Care program assists patients and families who are broken and wounded by mental illness to move toward wholeness.
The Behavioral Health Care program is a holistic approach to care, using standardized assessment tools that allow for a collaborative approach between you, your physician, and Home Healthcare, Hospice & Community Services as the home care provider. The program increases compliance with medication and medical follow-up, and decreases hospitalizations as well as emergency calls to physicians.
Master Level Social Workers experienced in Palliative Care
Nurses, Rehab Therapists, and LNAs working with a Palliative Care approach
- When faced with a new or ongoing chronic progressive illness such as cancer, heart, lung or kidney disease.
- When struggling with treatments and their side effects.
- If you or a loved one are simply having trouble understanding your condition and options, and are uncertain about the path ahead.
- Understanding and exploring ways to best manage unwanted symptoms, pain, and discomfort and optimize quality of life
- Finding resources to help with the practicalities and necessities of daily living
- Emotional support when you are at a crossroads and need to make difficult decisions
- Help with Advance Care Planning (ACP), including advance healthcare directives and Provider Orders for Life Sustaining Treatment (POLST)
Palliative Care Social Workers are trained ACP facilitators and will help you make sure your wishes are communicated, documented, and that
decision making burdens are eased for you and your family.
Butterfly Park, the City of Keene’s beautiful Community Space on Marlboro Street, is the traditional location for our event and we were thrilled to expand the butterfly release to a second location in 2022 and greatly enjoyed working with Cathedral of the Pines in Rindge. Both venues are fully accessible.
We’d love to have you join us! Send us an email at events@hcsservices.org to express your interest.
Absolutely! People of all ages are welcome at every event and our Saturday event is planned especially with families and children in mind. We will provide a few extra activities for our younger attendees. We hope you bring the whole family to join us!
We understand that sometimes plans change at the last minute or perhaps an illness crops up. If you are unable to attend, HCS will release the butterflies on your behalf at the end of the event time.
Funds raised and donations made through the Butterfly Release all go to support Hospice at HCS.
You may order as many butterflies as you like. Please remember to pre-order, as butterflies will not be for sale on the day of the event. You can order butterflies here: https://www.hcsservices.org/shop/
Yes! The event will take place rain or shine!
No, you may come at any time during the event window.
Palliative Care Support at HCS is available to patients receiving HCS home-based visiting nurse or rehabilitation services. Palliative Care at HCS requires a physician order and may be covered under insurance. Patients without insurance may be eligible for a grant-funded Palliative Care Social Work visit.
For more information, please call Care Coordination at HCS at 603-352-2253.
We have revised our sponsorship levels and named each level after butterflies found in New Hampshire. Each sponsorship level will have inclusion in our event marketing materials and a certain number of butterflies to release at the event.
If you would like to be a sponsor, reach out to us today!
$1000 – Monarch level
Includes 4 butterflies
$500 – Swallowtail Level
Includes 3 butterflies
$250 – Skipper Level
Includes 2 butterflies
$100 – Painted Lady Level
Includes 1 butterfly
No, you are welcome to come and enjoy the event without releasing a butterfly, however if you would like to release a butterfly (or several!) we recommend purchasing the butterflies through our shop well in advance. Butterflies sell out quickly and we often do not have extra on the day of to sell.
The dates for the 2024 Butterfly Release are:
- Thursday, June 20, 2024 at Cathedral of the Pines – Rindge, NH
- Friday, June 21, 2024 at Butterfly Park – Keene, NH
- Saturday, June 22, 2024 at Butterfly Park – Keene, NH
Save the date and plan to join us!
If you have a physical or mental disability that substantially limits one or more of your major life activities, you may request a reasonable modification to access the transportation service.
Requests may be made in writing or orally to: City Express Transportation Manager, PO Box 564, Keene, NH 03431 or cpratt@HCSservices.org or by calling 603-352-2253.
The ADA complaint form can be used to file a request for a modification.
The City Express allows trained service animals to accompany para transit riders. The service animal must be under your control at all times and not pose a threat to the health and safety of other riders. Please let the dispatcher know if you will be having a service animal traveling with you. Emotional support animals are not considered service animals per ADA regulations.
A VNA team member will try to call you on the evening before to schedule a visit for the next day. However, sometimes they may not be able to call until the morning of the visit. We are sorry when we cannot offer more notice. We get new patients added to the schedule every day. Sometimes, they are very sick and require urgent visits. This causes our homecare team members’ schedules to change. They will always try to give you an estimated time when they will arrive. Please answer your phone or return our calls promptly.
We understand the importance of building trust with your caregiving team. That is why we try our best to schedule the same team of clinicians to visit your home every time. Changes in time of day, day of week, and after-hours may impact our ability to schedule the same nurse or therapist, so we cannot guarantee the same provider every time.
For details about specific programs that HCS can offer, give us a call at 603-352-2253 or join us for Walk-in Wednesdays!
New riders are welcome! Sign up as a new rider by calling the dispatch office and giving your name, address, telephone number and directions to your home.
If you use assistive or mobility devices, please let the dispatcher know so that we can schedule the right amount of time for your pick up.
Your information is kept confidential, but having it on file will help our dispatchers respond to your ride request quickly.
The Para Express will pick up or drop off customers within 3/4 mile of the City Express fixed route service.
The Para Express operates the same hours as City Express buses.
Monday through Friday from 8 a.m. – 4:30 p.m.
- Riders must be outside and approaching the bus at their designated pickup time, which can be up to one hour before your requested time.
- All riders must remain seated while the bus is moving.
- Smoking, eating, and drinking is prohibited.
- Riders cannot bring packages or luggage on the bus that they cannot manage themselves.
- Bus drivers can help you on and off the bus at a stop. They cannot leave the bus to help you into or out of buildings.
Paratransit eligible visitors from outside the City Express service area may use the Para Express service for any combination of 21 days of service during a rolling 365-day period beginning with the visitor’s first use of service. Visitors who wish to receive service beyond this 21-day period must apply for eligibility as a Para Express rider. Contact our office for an application.
When the bus arrives, the driver will wait for five minutes for you to board and will then go on if you are not available. If you have not called to cancel your ride at least one hour prior to your pickup time, this is considered a “no-show.” Riders who have no-shows equal to or greater than 25% of their scheduled trips in a thirty (30) day period will be subject to a warning and possible suspension from riding. Should you be suspended, there is an appeals process which will be outlined in the suspension notice.
The fare to ride the Para Express is $2.00 per one way trip. Personal Care Attendants (PCA’s) ride free. Companions may ride with you as long as space is available and they have the same pick up point and destination. The fare for companions is $2.00 per one way trip.
Trip requests can be made Monday through Friday from 8:00 a.m.—5:00 p.m. Next day reservations must be made by 4:30 p.m. On Sundays, a voicemail can be left for the dispatcher to call you back on Monday. If leaving a voicemail, remember to leave a call back number.
Be sure to tell the dispatcher:
- The date and time of your appointment
- Where you would like to be picked up
- Where you are going
- If you will need a return ride, and when you will need that ride
Trip requests may be made up to 14 calendar days before your intended trip. You may cancel your ride up to one hour before the scheduled pickup time.
Trip Request Line: 603-352-8494
TTY: 711 or 800-735-2964
Trip Request Line – 603-352-8494
TTY: 711 or 800-735-2964
Trip requests can be made Monday through Friday from 8:00 a.m.—5:00 p.m. Next day reservations must be made by 4:30 p.m. On Sundays, a voicemail can be left for the dispatcher to call you back on Monday. If leaving a voicemail, remember to leave a call back number.
Be sure to tell the dispatcher:
✓ The date and time of your appointment
✓ Where you would like to be picked up
✓ Where you are going
✓ If you will need a return ride, and when you will need that ride
Trip requests may be made up to 14 calendar days before your intended trip. You may cancel your ride up to one hour before the scheduled pickup time.
The Para Express is complementary paratransit service to the City Express fixed route service to allow everyone access to the mobility that public transportation provides. If you are a person with a disability, you or your care provider may request an application to determine your eligibility for Para Express services by calling 603-352-8494. Information is also available in accessible formats.
The completed application may be submitted in person or mailed to:
Transportation Program at HCS
PO Box 564
312 Marlboro Street
Keene, NH 03431
- A follow-up may be scheduled with a healthcare professional from HCS to verify your transit disability.
- An eligibility determination will be made within 21 working days after the application and healthcare verification are received.
- You will receive a letter from the City Express with your eligibility determination. If you are eligible, you will be certified for a specific period of time, usually 6 months up to 2 years. Eligibility may also be granted on a seasonal or trip by trip basis. This will be outlined in your eligibility letter. You will need to reapply prior to your expiration date for recertification. The Para Express will send you a new application prior to your expiration date as a reminder to avoid any lapse in service.
- If you are not eligible, you may appeal the determination. The procedures for appeal will be outlined in the determination letter.
Call the HCS Transportation Office at 603-352-8494 to schedule your ride. The office is open from 8:00am to 4:30pm, Monday through Friday. HCS Medical Transportation is available on Wednesdays.
- You must call to reserve your seat by 2:00pm on Tuesday.
- Trips may be reserved two weeks in advance. Riders will be called with a pick-up time on Tuesday.
- If you need to cancel, please let us know as soon as possible.
- Please remember that the bus is scheduled to depart for Keene by 2:30pm. Please make your appointments so that you will be ready to return with us.
Reservation Line
HCS Transportation Office 603-352-8494
A donation of $1 for a one way trip is encouraged.
No one is denied service for inability to contribute.
Friendly Bus drivers are happy to assist you onto the bus with your packages. Drivers are also allowed to make one trip to your door to bring packages to a first floor door of your home, but cannot enter the house.
Riders may also bring a shopping cart aboard the bus to help with packages.
A regular trip is scheduled to Market Basket in Swanzey.
Call the dispatch office at 603-352-8494 for schedule information and reservations.
Yes! The Friendly Buses are equipped with lifts and other assistive devices for rider convenience when boarding and riding.
All drivers have CDL licenses with passenger endorsement, and have passenger assistance training to ensure a safe and comfortable trip.
Scheduling a ride is as easy as dialing 603-352-8494. The dispatch office is open Monday through Friday from 8am to 4:30pm. Rides must be reserved one day in advance. Rides on Mondays must be scheduled on Friday.
In order to accommodate everyone, the dispatcher may ask you to board a little earlier in order to share a ride with someone else. Use the extra time to get to know someone else who is riding, read a book, make a grocery list, or enjoy the sites around Keene!
Please let the dispatcher know if you use a mobility device, such as a walker, cane, or have oxygen so that we can better assist you.
The Friendly Bus operates Monday through Friday from 8am to 4pm, excluding major holidays.
Ask your doctor to consider a referral to Home Healthcare, Hospice & Community Services if you can benefit from services due to:
- Joint replacement surgery, such as hip or knee replacement
- Stroke
- Heart failure or heart attack
- A noticeable decline in functioning, such as difficulty walking, loss of balance, or falls
Physical and Occupational Therapy services are covered by most insurances and Medicare when ordered by a physician who has evaluated your condition within the last sixty days.
In order to be covered by Medicare, you must also be homebound, which is defined as not able to leave your home without “considerable and taxing effort.”
Yes. There are several other options that can be of further help, including:
- Skilled nursing when ordered
- Coumadin blood level monitoring
- Staple/suture removal
- Wound assessment
- Dressing changes
- Support services
If you have diabetes, problems with your circulation, or neuropathy, you will need a referral from your doctor. Otherwise, a referral is not needed. Please have your doctor fax the HCS Foot Care Referral Form to us at 603-242-1534.
Palliative Care is an approach to care that focuses on relief from symptoms, pain, and stressors – whatever the stage of the illness. Palliative Care Support at HCS is an extra layer of support that can be offered to our patients while receiving home-based visiting nurse or rehabilitative services. As this layer of support is provided within skilled home care services, it is short term in nature. Palliative Care Support at HCS is a person-centered, Social Work-led service that prioritizes your needs, concerns, and wishes for your best quality of life.
- Support includes:
Palliative Care Conversations in which we get to know you and your goals - Evaluation of pain and discomfort
- Support navigating the healthcare system, understanding options and resources, and coping with your situation
- Guidance in weighing and making choices – both practical and complex
- Assistance around any area of stress impacting your quality of life
Hospice is medical care with the goal of comfort and dignity for someone whose life is drawing to a close. It is, in fact, the “something more” for someone who has been told nothing more can be done for them. Hospice provides high-quality pain management and symptom control with the goal of making people as comfortable as possible.
Hospice patients receive care from registered nurses who specialize in hospice care, home health aides, social workers, spiritual care counselors, and bereavement staff. Patients keep their own physicians, but we do have a hospice medical director who is Board Certified in Hospice and Palliative Care overseeing care.
This “interdisciplinary team” coordinates the care and support for the patient and family. In addition to the professional staff, volunteers are available to help patients and families, providing respite, sitting with patients, taking them out for a ride, and generally being a “good neighbor.”
Not anymore. When hospice began in the mid 1970s, most hospice patients had cancer. Today, while many hospice patients still have cancer, the majority have other life-limiting illnesses such as end stage heart, lung, or kidney disease, or Alzheimer’s dementia.
Hospice care is provided wherever people call home — their residence, assisted living facility or nursing home.
Medicare covers 100% of hospice services. Hospice can also accept Medicaid, Veterans administration benefits and private insurances.
Although end of life care may be difficult to discuss, it is best for family members to share their wishes long before it becomes a concern. This can greatly reduce stress when the time for hospice is needed. By having discussions in advance, people are not forced into uncomfortable situations. Instead, individuals can make educated decisions that include the advice and input of family members and loved ones. Hospice at HCS will meet with individuals and families to explain hospice care. No physician order is needed, and informational visits are made at no charge.
Hospice focuses on living life to the fullest while experiencing a life-limiting illness. Hospice is a holistic approach to end of life care, focusing on quality of life and offering physical, emotional and spiritual comfort.
Yes, there are several additional benefits including:
- Help with obtaining necessary medical and/or assistive devices
- Support and education for family members who are helping you
- Bed mobility and transfer training
Each foot care appointment costs $50. Many clients from towns within the HCS service area will only need to pay $25 if they attend the clinic closest to their home as town funding covers the other half of the appointment cost. If you choose to go to a service location that is not the nearest, or are out of the HCS service area, you will need to pay the full fee.
Call Home Healthcare, Hospice & Community Services at 603-352-2253.
Appointments for all foot clinic sites are made through the main office.
Transportation is available to those needing rides to medical appointments. Priority is given to those over age 60, veterans, and individuals with disabilities.
Rides for priority groups will be scheduled on a first come, first serve basis. Others with a medical appointment may ride on a space available basis.
Children under 18 must have a parent or legal guardian accompanying them. Family members or friends may accompany to assist.
Transportation is also available Monday through Friday to
- The VA Outpatient Clinic at 640 Marlboro Street in Keene
- To all Dartmouth-Hitchcock medical facilities in Keene.
Call HCS Transportation at 603-352-8494 for route and schedule information for the Friendly Bus for seniors (60+) and the City Express, Keene’s Bus for Everyone.
A donation of $20.00 is suggested for the round trip to help defray the cost. No one will be refused medical transportation due to inability to donate.
The vehicle is fully accessible for up to 11 passengers. Wheelchairs can be accommodated depending on their size. The ambulatory seating available varies according to the number of mobility devices on the trip.
Medical transportation is available every Wednesday. Medical transportation is a shared ride service and departure times may vary to coincide with the first appointment.
For everyone’s convenience, please make appointments between 9:00am and 1:00pm.
- 8:00am Prompt departure from HCS at 312 Marlboro Street in Keene
- 10:00am *Arrival at VA Medical Center in White River Junction
- 10:30am *Arrival at Dartmouth—Hitchcock Medical Center in Lebanon
- 2:30pm Prompt departure from Dartmouth—Hitchcock for return trip
- 2:45pm Prompt departure from VA Medical Center
- 4:30pm *Arrival at 312 Marlboro Street in Keene
If you are not able to return at 2:30pm, please make arrangements for alternative transportation to your home.
*Arrival times are approximate.
Medical Transportation departs from the HCS office at 312 Marlboro Street in Keene. If necessary, riders can be picked up at their home in Keene. Riders from outlying communities are requested to meet the bus at the HCS office. Ample parking is available if riders choose to park and ride. Pick-ups can also be made along the route.