How to Choose a Hospice Provider
Not all hospices are equal. Here's how to evaluate Medicare certification, accreditation, CMS quality ratings, and the right questions to ask — so you find the best fit for your family.
Not all hospices deliver the same level of care. While all Medicare-certified hospices meet minimum federal standards, there can be significant differences in:
- How quickly they respond to after-hours calls
- How consistently nurses visit (some hospices underserve patients at end of life)
- Whether they offer inpatient hospice care for crisis situations
- The depth of spiritual, emotional, and social work support
- Communication quality with family caregivers
- Specialized programs (pediatric hospice, dementia care, ALS, etc.)
CMS data shows that hospice enrollment in the last three days of life is a quality red flag — patients who enroll earlier receive more comprehensive support. The median hospice length of stay in the U.S. is about 18 days, but ideally patients should enroll weeks or months before death to receive the full benefit.
Medicare Certification (Required)
Any hospice billing Medicare must be Medicare-certified and meet the CMS Conditions of Participation. Certification requires passing an on-site survey that evaluates clinical quality, staffing, patient rights, and administrative compliance. Never choose an uncertified hospice if you're using Medicare.
You can verify certification at medicare.gov/care-compare → select "Hospice" and search by ZIP code or agency name.
Voluntary Accreditation (Higher Bar)
| Accrediting Body | What It Means |
|---|---|
| CHAP (Community Health Accreditation Partner) | Oldest hospice accreditor; focus on community-based care quality |
| ACHC (Accreditation Commission for Health Care) | Comprehensive standards; peer-review process |
| The Joint Commission | Well-recognized across healthcare; advanced certification for palliative care |
| NHPCO Membership | Not accreditation, but membership in National Hospice and Palliative Care Org signals engagement with best practices |
Accreditation is voluntary — the absence of accreditation doesn't mean a hospice is poor quality, but its presence is a positive signal.
Ask these questions when interviewing a hospice agency. A reputable hospice will answer clearly and without pressure.
- What are your nurse-to-patient ratios?
- Who answers calls after hours — a nurse or an answering service?
- How quickly will a nurse arrive if there's an emergency?
- Do you have a dedicated on-call physician?
- Do you have an inpatient hospice facility, or do you use hospital beds only?
- Do you offer specialized programs for dementia, ALS, heart failure, or pediatric patients?
- How often will a chaplain or social worker visit?
- Do you provide continuous home care (crisis care) when needed?
- How quickly can you deliver medical equipment like hospital beds or oxygen?
- Who manages medication changes and refills?
- What happens if I need a medication that isn't on your formulary?
- What respite care options do you offer for family caregivers?
- What bereavement support will my family receive after death?
- How do you communicate with out-of-town family members?
CMS Hospice Compare is the official government database for evaluating hospice agencies. It reports data from CMS surveys and from the CAHPS Hospice Survey (family caregiver interviews after death).
Key Metrics on Hospice Compare
| Metric | Why It Matters |
|---|---|
| Patients who got timely home visits | Measures whether nurses visited frequently enough as patients neared death |
| Patients whose symptoms were well-managed | Covers pain, shortness of breath, and other key comfort measures |
| Patients treated with respect | From caregiver survey — reflects dignity of care |
| Family felt well-informed | Critical for caregiver peace of mind and decision-making |
| Emotional/spiritual support provided | Measures non-clinical team engagement |
| Would recommend this hospice (overall rating) | Top-line family satisfaction metric |
You can also search our local hospice provider directory to find Medicare-certified agencies near you with key quality ratings pre-populated.
These signs should prompt you to look for a different provider or ask serious follow-up questions:
Pressure to enroll quickly
Reputable hospices give you time to decide. Aggressive enrollment sales tactics are a red flag, especially if they downplay the hospice election requirements.
Vague answers about after-hours coverage
If the hospice can't clearly explain who answers calls at 2am and how fast a nurse will arrive, that's a problem. Nights and weekends are often when patients need the most support.
No inpatient or continuous care option
Hospices are required to offer all four levels of care (routine home care, continuous home care, general inpatient care, respite care). If a hospice says it only does routine home care, that's a compliance issue.
CMS survey deficiencies
Check if the hospice has active CMS survey deficiencies or complaints at medicare.gov/care-compare. Isolated minor deficiencies are common; repeated serious violations are not.
Low family satisfaction scores
If fewer than 75% of families would recommend the hospice on CMS surveys, investigate further or choose a higher-rated provider.
Long waits for equipment delivery
Hospital beds, wheelchairs, and oxygen should typically be delivered within 24–48 hours of enrollment. If a hospice quotes longer timelines, escalate or find another provider.
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