A professional salesman (MaryAnn) signed us up with guarantees if we had problems she would assist. No response to over 15 messages/calls. Turnover of nurses (mostly inexperienced) leads to no consistency for quality client care. We had approximately 8 Nurses in a year. Took the MD almost 5 months before meeting our hospice loved one and family but constantly wanted to progress to Narcotics prior to need. The MD & RN's did not know the history or current diagnosis although they meet weekly to discuss the plan of care of which the family is not invited to attend. Signed up with Vitas because they allegedly have Respiratory Therapist( RT) on staff. RT came once & maybe called twice in the past year for a COPD client. THEY DID NOT FOLLOW THE DISCUSSED AND AGREED UPON PLAN OF CARE. The last few days the care and medication administration was extremely aggressive making everyone in the family very uncomfortable. Bottom line....... a horrible experience for a most beloved person. I would rate a zero if possible and highly recommend using a different hospice agency.