How to choose a hospice: questions that reveal the real differences

Every Medicare-certified hospice offers the same benefit on paper. What differs is how quickly someone answers at 3 a.m., how often a nurse visits, and whether the team is there when it matters most. Those differences are worth a few phone calls.

Know your rights first

• You choose. A hospital, doctor or facility may recommend a hospice, but the choice is yours.
• You can switch. Medicare lets a patient change hospice providers once in each benefit period.
• You can stop. Hospice is not a one-way door. A patient can leave hospice at any time and return to treatment.

Start with the data

Search by ZIP code on Medicare’s Care Compare and look at three things:

1. Family caregiver survey rating. A star summary from the CAHPS Hospice Survey, completed by family caregivers after a patient’s death. Open the details to see scores for communication, getting help with symptoms, and timely care.
2. Hospice Visits in the Last Days of Life. Whether staff visited when death was near.
3. Hospice Care Index. Ten indicators combined, including gaps in nursing visits and whether the hospice ever provides higher levels of care.

Then narrow to two or three hospices and call. The questions below are designed to get beyond the brochure.

Questions to ask on the phone

Responsiveness

• If we call at night or on a weekend, does a nurse answer, or an answering service? How long until a nurse calls back, and until one can be at the house?
• How soon after a referral can you do the first visit?

Visits and staffing

• How often will the nurse visit at first, and how does that change as needs grow?
• How many patients does each nurse carry?
• Will we usually see the same nurse and aide?
• How often will an aide come to help with bathing?

Higher levels of care

Medicare recognizes four levels of hospice care: routine home care, continuous home care during a short crisis, inpatient respite care, and general inpatient care when symptoms cannot be managed at home.

• Do you provide continuous home care? How often have you done it in the last year?
• Where would general inpatient care happen if pain or breathing got out of control?
• Where would respite happen if the family caregiver needs a break? Medicare allows inpatient respite stays of up to 5 days at a time.

The whole family

• What does the social worker help with, and how often do they visit?
• Is chaplain support available for our faith, or for no faith at all?
• What bereavement support do you offer after a death, and for how long?
• Do you have volunteers who can sit with our loved one so we can rest?

If your loved one lives in a facility

• Do you already serve residents at this assisted living or nursing home?
• How will your team coordinate with facility staff, and who do they call first?

What it costs

With Original Medicare, hospice care costs $0. There may be a copayment of up to $5 per prescription for symptom drugs and 5% of the approved amount for inpatient respite. Room and board in a nursing home or assisted living is not part of the Medicare hospice benefit.

Warning signs

• Someone shows up uninvited offering hospice, or pressures you to sign up a person whose doctor has not discussed it.
• Promises of free extras that have nothing to do with care.
• Vague answers about after-hours response or visit frequency.

For a broader look at hospice in our state, see hospice in Utah. If you are still deciding between comfort care and recovery-focused care, read hospice vs. home health.

When a facility already has a hospice it prefers

If your loved one lives in assisted living or a nursing home, staff may suggest a hospice they work with often. That can be a real advantage, since the teams already know each other. It is still your decision. Ask the facility which hospices currently serve its residents, compare them the same way, and choose the one that answers your questions best.

Write down what matters to your loved one

Before you call, take a few minutes with your family to list what matters most. Staying at home to the end? A chaplain from their own faith? Help for an exhausted spouse at night? Keeping a beloved pet close? A hospice that hears those priorities and explains how it will meet them is more likely to be the right fit than one that only recites its services.

After you choose

Once the hospice is selected, the admission visit usually happens within a day or two. A nurse reviews medications, explains which drugs and equipment the hospice will provide, and leaves a phone number to call any time, day or night. Post that number on the refrigerator and save it in every family member’s phone. In a hospice crisis, that number, not 911, is usually the first call, unless someone is in danger.

Common questions

How do I choose the best hospice near me?

Compare the family caregiver star rating and last-days visit measure on Care Compare, then call two or three hospices with the questions above. Pay attention to how they answer the after-hours question.

Can I change hospice companies?

Yes. You may move to a different hospice once during each Medicare benefit period.

Do all hospices provide the same services?

All Medicare hospices must provide the same covered benefit, but visit frequency, response times, and use of continuous or inpatient care vary a great deal.