How to choose a hospice: where to look, what to ask and the warning signs

Most families choose a hospice once, and often in a hurry. The choice is theirs to make. The person gets hospice care from the hospice they choose,¹ and Medicare only covers that care when the hospice is Medicare-approved.² This note covers where to look a hospice up, the questions worth asking on the first call, the warning signs, and what to do if the fit turns out wrong.

The short answer

• The person and family choose the hospice. Ask the doctor for names, and call more than one.¹
• Make sure it’s Medicare-approved.²
• Look it up on Medicare’s Care Compare, which publishes what family caregivers reported,³ and on Cal Health Find, California’s record of licenses, complaints and enforcement actions.⁴
• Never accept gifts or perks for signing up, and never give your Medicare number to someone you don’t know.⁵
• If the fit is wrong, the person can change hospices once in each benefit period.²

Where to look a hospice up

Medicare’s Care Compare. Medicare publishes the results of the CAHPS Hospice Survey on Care Compare. The survey asks the primary caregivers of patients who died in hospice about starting care, help with symptoms, communication with the team, their own experience, an overall rating and whether they would recommend the hospice. Results cover eight quarters of surveys and are updated every quarter.³

Cal Health Find. The California Department of Public Health’s Cal Health Find shows a health facility’s ownership, licensing and certification status, and its history: complaints, reported incidents, state enforcement actions and deficiencies found by state inspectors.⁴

Numbers and ratings are a starting point. The first phone call tells you a lot too: who answers, how long it takes, and whether your questions get straight answers.

Questions to ask on the first call

• Are you Medicare-approved and licensed in California? Medicare only covers hospice care from a Medicare-approved hospice.²
• Who answers at night, and how soon can a nurse come? A hospice nurse and doctor are on call 24 hours a day, 7 days a week.² Ask what that looks like at 2 AM, and how long a night visit usually takes to arrive.
• How often will the nurse, the aide and the social worker visit? Visits follow the plan of care, which the hospice team writes with the attending doctor.⁶ Ask for a copy of the plan.⁷
• What happens if symptoms get out of control at home? Medicare’s hospice benefit includes short-term inpatient care for pain and symptom management, and short-term respite care.² Ask where the hospice provides them. The four levels of hospice care explains them.
• Do you have nurses and aides who speak our language? Ask about the people who will come to the house, as well as the person who answers the phone.
• Can our own doctor stay involved? The person can choose to include their regular doctor.²
• What will the family pay? With Medicare, up to $5 per prescription for pain and symptom medicines, and 5% of the Medicare-approved amount for inpatient respite care. Room and board isn’t covered by the hospice benefit.²
• What support do you give the family after a death? Hospices must have a bereavement program for the family, available for up to a year after the death.⁸

The warning signs

Medicare’s advice is direct: never accept perks or gifts in return for signing up for hospice, and be suspicious if someone offers free services like housekeeping or cooking in return for a Medicare number. Only a doctor can certify that someone is terminally ill, and a person who isn’t terminally ill shouldn’t receive hospice care.⁵

California’s Department of Justice lists other warning signs: pressure to sign, unclear answers about costs, services the person doesn’t need, billing errors, frequent changes in the care plan, high staff turnover and a hospice that doesn’t respond to concerns. Its advice is to ask for explanations and documentation of every service and cost, keep copies of the care plans, and consider another hospice if your questions don’t get answered.⁷

To report suspected fraud, call 1-800-MEDICARE (1-800-633-4227).⁵ In California, you can also call the Division of Medi-Cal Fraud and Elder Abuse at (800) 722-0432.⁷

If the fit turns out wrong

The person can change hospice providers once during each benefit period, and can stop hospice at any time.² Can you leave hospice? explains how both work.

If something about the care isn’t right, say so early, to the nurse and then to the hospice’s leaders. Your rights as a hospice patient lists who else to call, in order.