Finding Hospice Care

At first glance, it might appear that the difference between for-profit and non-profit hospice providers is merely the way they structure their businesses. That is, for-profit entities gear their business activities towards generating income for owners and investors, while nonprofits use the business proceeds to fund programs and services. The principals and employees of a nonprofit are paid a salary, but they don’t share in the profits the business earns. Additionally, for-profit entities are usually funded by private entities such as banks, venture capitalists and private equity firms who expect to see a return on their investments. Nonprofits are funded by donations or endowments. While they need to remain financially solvent, the pressure to generate revenue is far less.

The difference between these two business models inevitably impacts how the business is run. In the hospice industry, this generally means that for-profit hospice providers focus more on optimizing revenue than other aspects of care. For example, for-profit hospices enroll a higher percentage of patients with dementia — a population that, in general, has a longer illness trajectory and fewer acute care needs than people with illnesses such as cancer and chronic obstructive pulmonary disease. These patients cost less to care for and stay in hospice longer than most other populations. And because Medicare reimburses hospices at a fixed per-diem rate, they generate more revenue than patients who are seriously ill and near death. 

For-profit hospices also tend to fall short in caring for patients in the last days of life.  

According to a 2019 report from the U.S. Government Accountability Office, out of all hospice providers surveyed, 83 failed to provide a patient visit by hospice staff (such as a doctor or RN) during the last three days of life. Of these providers, 80 were for-profit while only three were not. 

Another stark difference between for-profit and nonprofit hospice providers is the number of patients discharged while still alive. According to the GAO report, significantly more for-profit hospices discharged 50% or more of their patients prior to death than nonprofits (out of 472 hospices that fell into this category, 462 were for-profit entities). This disparity could indicate higher levels of patient dissatisfaction with the care provided by for-profit providers. Or it could mean that for-profit providers are accepting patients who actually don’t qualify for hospice because they have more than six months to live. Even more disturbing is the possibility that patients are being forced out of hospice when they are close to death, as their care needs become more acute and cost the hospice more to provide. 

Lastly, for-profit hospices tend to enroll a high percentage of patients who reside in nursing homes. This, too, allows the for-profit agencies to provide less direct hands-on care, since nursing homes typically have full-time staff that can attend to many of a hospice patient’s needs. 

With all that being said, some for-profit hospice programs provide excellent care, while some nonprofits fall short. That’s why it’s so important to do your homework and find a provider that will meet your needs. 

Sources

“Hospice Care”. VeryWell Health. https://www.verywellhealth.com/hospice-care-overview-4581951 

“Medicare Hospice Care: Opportunities Exist to Strengthen CMS Oversight of Hospice Providers”. United States Government Accountability Office. https://src.bna.com/MQG?_ga=2.70655702.737881090.1574109848-61404479.1574109848

We encourage you to download and print out a list of these questions for each provider you will be interviewing. (We suggest you narrow it down to no more than three by reviewing star ratings and other factors before you proceed. )Then note their answers in the space provided below each one. You can download a printable copy of the questions by clicking the button below. 

As with all choices in life, the best way to make a good decision is to do your homework and learn all you can about the options available to you. As a starting point, ask your primary care provider or treating specialist if they have experience with any of the hospice providers on your list. Most doctors are more than willing to give patients their opinion about which hospice might be the best fit for them. You may also want to speak with friends and family. Perhaps someone you know has had experience with hospice and can give you their perspective on what was most important to them. 

The next step is a crucial one: Interview all the hospice providers on your list, in person if possible, to get answers to the questions that are most important to you. Set up the appointment in advance, and arrive armed with a list of things you want to know more about. According to the Hospice Foundation of America, here are some of the questions you should ask:

Response Times

• How quickly will the hospice respond if the plan of care is not effectively controlling symptoms? What is the typical response (e.g., home visit, phone guidance, prescription adjustment)?
• How quickly will the hospice respond in an emergency?
• What is the typical response time for after-hours calls (evenings, nights, weekends, and holidays)?
• Will the hospice treat related conditions, such as urinary tract infections, or will the patient need care elsewhere?
• How soon can we expect symptoms such as pain, anxiety, or shortness of breath to be controlled?

Hospice Staff & Volunteers

• How quickly will a plan of care be developed?
• Which staff members and volunteers will visit, and how long will visits typically last? (Note: Some families prefer more privacy and fewer staff visits—if so, discuss this.)
• Will the same nurse provide ongoing visits?
• Do hospice staff members have specialized training or certifications in hospice or palliative care?
• How many patients are assigned to each hospice nurse?
• (Nurse Julie recommends no more than 12–15 patients: hospicenursejulie.com.)

Medications and Supplies

• Does your agency provide a hospital bed?
• What medical supplies does hospice provide?
• What supplies and/or medications, if any, will we need to obtain ourselves?
• Does hospice deliver medications, or will we need to pick them up? If pickup is required, where?
• Can I continue taking my current medications?
• Do you provide medical cannabis to hospice patients in states where it is legal?

Family Involvement and Respite Care

• What care are family members expected to provide?
• How does your agency train and keep family members informed about the patient’s condition?
• How will family members be educated about what to expect as the illness progresses?
• Will hospice staff provide training and ongoing guidance to family caregivers?
• Does the hospice provide respite care for family caregivers? How often, and how is it arranged?
• If inpatient care becomes necessary, how will the hospice manage that transition?
• Does the hospice provide bereavement support? If so, how is it provided and by whom?

Quality of Care

• How do you balance a patient’s choice to go—or not go—to the hospital if needed?
• Does the hospice report quality data to the Centers for Medicare & Medicaid Services (CMS) Hospice Compare program?
• Is the hospice accredited by the Joint Commission or the Community Health Accreditation Program (CHAP)?
• If we are unhappy with some aspect of care, how do we contact an administrator? Who specifically should we call?
• How do you coordinate care with my doctor if I choose to continue seeing them?
• (Federal law allows this while on hospice.)

Length of Care

• How long can my loved one remain in hospice care?
• Are patients ever discharged from hospice while still alive? Under what circumstances might that occur?
• (SevenPonds flags this as an important question, as it may raise ethical concerns—particularly if a patient is discharged close to death due to the financial burden of care not covered by Medicare.)

Costs

• Excluding required co-pays, are there any hospice-related costs not covered by Medicare?
• Will the agency accept my insurance?
• How does the agency handle billing and payments?

Patient/Caregiver Satisfaction

• Do you participate in the Medicare Family Caregiver Experience Survey?
  If so, how can we access the survey to provide feedback?
• If you do not participate in the Medicare survey, how can we submit feedback or concerns?

This list is provided to you at no charge by Sevenponds.com. If you found this helpful, we encourage you to visit us at SevenPonds.com where we offer information, education and advice about all of your end of life needs. Please feel free to share this with anyone you know who may find it useful.

We always love hearing from our readers and welcome any feedback at wecare@sevenponds.com.

© 2026 SevenPonds. For personal, non-commercial use only.

Sources
“How to choose a hospice provider”. Hospice Foundation of America. https://hospicefoundation.org/how-to-choose-a-hospice-provider/ 

“About Us”. Community Health Accreditation Partner. https://chapinc.org/ 

Medicare ranks hospice providers based on a number of quality measures, including a star-rating system based on responses from caregivers to the family caregiver experience survey. Also known as the Consumer Assessment of Healthcare Providers and Systems Hospice survey, it measures the quality of care in six different domains, including:

• Communication with family caregivers
• Timeliness of help
• Respect for the patient
• Emotional and spiritual support
• Treatment of pain
• Family/caregiver training

Additionally, the survey measures two global dimensions of care, the family’s overall rating of the hospice and their willingness to recommend the hospice to others. 

Medicare aggregates the responses of family caregivers for each participating hospice and provides the results on Care Compare, a service offered by the U.S. Centers for Medicare and Medicaid Services that provides information on hospice providers, hospitals, nursing homes, home health agencies and other health care providers located throughout the United States. The website provides general information, such as the type of facility, the location, how many patients the hospice serves on average per day and how long the hospice has been providing care. It also indicates whether the hospice is a for-profit or non-profit entity and ranks each participating hospice on quality measures set by CMS. The site does not, however, have information on every hospice provider currently operating in the U.S. 

To use Hospice Compare, go to Medicare.gov/Care Compare, then:

• Select Hospice from the menu on the left, then enter your ZIP code in the box marked My Location, and click Search. (If you want to look at a specific provider you may enter the name on this page as well.) A list of providers in your area should appear. 
• To compare providers side-by-side, click the box labeled “Compare” next to each provider you would like to include. When you have selected all the providers you want to see, click the white box labeled “Compare” at the top right of the page. 
• A new page will open. At the top will be the name and phone numbers of the selected providers and the type of organization (nonprofit or for-profit). Below this will be a side-by-side comparison of the providers, starting with the date each agency was certified by Medicare. 
• Next, choose one or more of the categories listed to compare the agencies side by side. The categories should be:
  • Conditions Treated— lists the most common conditions treated by the provider by percentage and compares them to the national average. 
  • Location of care — e.g. home, nursing home, assisted living, inpatient hospital, inpatient hospice or others
  • Level of care provided — e.g. routine home care only or routine home care plus at least one additional level of care 
  • Family caregiver experience — quality measures collected by Medicare, including the following:
    • Communicating with family
    • Getting timely help
    • Treating patient with respect
    • Providing emotional and spiritual support
    • Training family to care for patient
    • Help for pain and symptoms
    • Overall rating of hospice
    • Would recommend

Next to each parameter is a percentage, which is based on results from a national survey that asked family members about their experience with the hospice. To the right of that result is the national average score. 

• Quality of care — this includes two measures shown as percentages:
  • Percentage of patients getting at least one visit from a registered nurse, physician, nurse practitioner, or physician assistant in the last three days of life
  • Patients who were assessed on all 7 HIS quality measures at the beginning of hospice care to meet the HIS Comprehensive Assessment Measure requirements:
    • Preferences for hospitalization and/or resuscitation
    • A discussion of values and beliefs
    • Initial pain assessment
    • Timely additional pain assessments if pain is identified as a problem
    • Assessment for shortness of breath on admission
    • Timely treatment for shortness of breath
    • Treatment for constipation in patients taking opioids for pain

Using the tool can be a bit time-consuming and tedious. However, it can provide you with a very helpful window into the hospice providers in your area and the type and quality of care they provide. 

Sources

“CAHPS® Hospice Survey”. Centers for Medicare & Medicaid Services. https://www.cms.gov/medicare/quality/hospice/cahpsr-hospice-survey 

“Medicare Care Compare”. Medicare.gov. https://www.medicare.gov/care-compare/ 

Based on personal experience, our Founder Suzette Sherman at SevenPonds recommends the Medicare.gov Hospice Compare website to select a hospice provider. Family members are allowed to select any hospice they choose and need not use the one recommended by their GP. This website not only offers the profit or nonprofit status of each hospice but also a star ranking based on reviews of family members. These rankings are based on questionnaires filled out by family members at the end of their experience. 

Keep in mind, it is best not to search for a hospice at the last minute since they are not always able to take new patients. You may have to contact several different hospices before finding options with open availability. Additionally, not all of the providers shown on the website may cover your area. SevenPonds recommends you interview at least two potential hospices prior to making a decision, and we provide a downloadable list of questions to ask while interviewing the agency. All hospice agencies will send a representative to your home location to introduce themselves and provide you with information about their agency.

In most cases, patients and families can obtain a list of licensed hospice programs in their area through their primary care physician or treating specialist. If the patient is hospitalized, the hospital discharge planner and/or case worker will also assist the family in finding a program that will fit their needs. The patient and their family will ultimately make the final decision, but these professionals are usually quite knowledgeable about the quality of care and level of service provided by hospice providers in their geographical area. If your doctor or hospital doesn’t provide you with a list of nearby hospice programs, you can reach out to your State Hospice Association for assistance. 

In addition to state agencies, there are a number of national organizations that help patients and families navigate the system and arrange hospice care. The following organizations offer online databases that allow clients to search for hospice programs by name, location and/or zip code.

• The National Hospice and Palliative Care Organization
• National Hospice Locator 
• National Association for Home Care and Hospice
• Medicare.gov/Hospice Compare 

The American Cancer Society is also available to help patients in some areas locate hospice care. To learn more, call 1-800-227-2345 or search for available resources online.

Keep in mind, too, that all hospice programs are not alike. Although Medicare and Medicaid require all licensed hospice providers to offer the same levels of care, the quality of care can vary greatly depending on staffing levels, staff training and the availability of volunteers. Choosing the best provider means doing your homework and finding out as much about each program as you can. At minimum, any program you consider should be certified by Medicare and licensed by the state. But there are many other issues to consider as well. 

Sources 

“ACS Patient Programs and Services”. American Cancer Society. https://www.cancer.org/support-programs-and-services.html 

“Hospice Analytics”. National Hospice Locator. https://www.nationalhospicelocator.com/ 

“Find a Provider”. National Alliance for Care at Home. https://allianceforcareathome.org/find-a-provider/ 

“Hospice Care and Compare”. Medicare.gov. https://www.medicare.gov/care-compare/compare?providerType=Hospice&providerIds=261557,261623,261559&city=Kirksville&state=MO&zipcode=63501