Basic services
Most hospice providers offer the same basic services.
Because most hospices participate with Medicare, they operate in accordance with Medicare regulations. These rules have been adopted as an industry standard, and they apply to the care of all hospice patients, regardless of insurance coverage.
Under Medicare regulations, a hospice provider must, at minimum, have the necessary resources to provide these four levels of care:
- Routine home care: The most common level of hospice care, typically provided at home for patients who are generally stable and whose symptoms, such as pain and nausea, are adequately controlled.
- Continuous home care: Short-term crisis-like care, usually provided at home for patients whose pain and/or other symptoms require additional management to bring them under control.
- General inpatient care (GIP): Short-term crisis-like care for patients whose uncontrolled pain and/or other symptoms require additional management in a medical facility, such as a hospital or nursing home.
- Respite care: Temporary care provided in a nursing home, inpatient hospice facility, or hospital so the patient’s caregiver can take time off. Unlike other levels of care, respite care is tied to the family caregiver’s needs, not patient symptoms.
Medicare coverage
It is important that patients enrolled in Medicare receive hospice care from a Medicare-certified provider. Some private insurers and Medicare Advantage plans may require a “preferred provider” that has insurance-negotiated rates.
Other considerations
Patients and their families may find one hospice more appealing than another based on differences such as:
- Availability, frequency, and type of volunteer services.
- Length of service to the community.
- Religious affiliation.
If time allows, families should choose a provider based on the patient’s needs, preferences, and insurance.
Compare hospice providers
The Centers for Medicare and Medicaid Services has a helpful tool for finding and comparing providers. This U.S. government website is the only searchable database of Medicare-certified providers that measures quality and other information based on family feedback and data.
Some hospice providers believe these metrics do not tell the full story about the care they offer. Other sources of information may include:
- Professional opinions. Ask clinicians, professional caregivers at nursing homes, geriatric care managers, or end-of-life doulas about their experience with the hospice(s) you are considering.
- Friends, family, and neighbors. Talk to those who have used hospice services and get their opinions about the provider.
- Accrediting agencies. Accreditation means that a third party has determined the hospice meets or exceeds an established standard of care. Find out whether a hospice is accredited by the Joint Commission or by the Community Health Accreditation Program. Accreditation is not required, and not having accreditation does not mean a hospice is substandard.
- Your state hospice association’s website. Some state hospice associations provide online directories of their members and information about these hospice providers.
If requested, hospice providers usually will send someone to meet with the prospective patient and family to discuss eligibility, describe the services provided, and answer any questions.
When scheduling this appointment, verify that there is no charge for the visit and no obligation to choose that provider. If possible, prepare questions before the meeting. Have a friend or family member attend the meeting to act as an advocate and take notes.
Questions to ask
The answers to these questions may help you decide which hospice will be the best fit.
- How quickly will the hospice team develop a plan of care? Will it be shared with the family and caregivers?
- What is expected of family caregiver(s)? Will the hospice provide training if needed?
- How often will a hospice team member visit? How long do most visits last?
- When the hospice orders medication, is it delivered? If not, where can it be picked up?
- What is the typical response time if caregivers need to reach the hospice team after normal business hours, on weekends, or on holidays?
- Will the hospice send a registered nurse, nurse practitioner, or physician to the home if the patient’s symptoms are not being managed? How long will it take the nurse/doctor to arrive?
- What does the hospice do when a patient’s symptoms cannot be managed adequately at home?
- If the need for inpatient hospice care arises, how will the hospice respond? Where will inpatient care be provided?
- Are there any services, medications, or equipment that the hospice doesn’t provide? (Hospice providers are required to share this information, as well as the reason medications, services, or equipment will not be covered.)
- What out-of-pocket expenses should the family anticipate?
- Can the hospice provide respite care to give family caregivers a break? How does the hospice arrange respite care? Where will the patient go during respite care — a hospice inpatient unit? A local nursing home?
- What help do your hospice volunteers provide? How do we ask for that help?
- Does the hospice have any data on quality it can share?
- If a hospice team member is not present at the time of death, will the hospice provide guidance and support for the family?
- What bereavement support is available?
- If the patient or family is unhappy with some aspect of care, who should we contact at the hospice organization? How do we reach that person?
Special considerations
Special circumstances may influence which provider you choose. When interviewing a prospective hospice provider, be sure to raise these issues if they apply.
- Is the patient a member of the LGBTQ+ community? If there are concerns about care, ask whether the hospice provides education and training to its hospice team and has a non-discrimination policy.
- Does the patient/family speak a language other than English? Establish that the hospice will promote effective communication by providing interpreters or staff who can speak the language whenever possible.
- Does the patient have an intellectual or developmental disability? Ask whether the hospice team is trained and prepared to provide optimal care for this patient.
- Do others in the household have special needs? Make the hospice provider aware of those needs and determine how they may affect the household and patient care.
