By Alicia Bloom, Empassion COO 

Choosing hospice care is one of the most important decisions a family can make—and one of the hardest. 

In my 20 years in hospice and palliative care, beginning as a social worker at the bedside, I have had the privilege to walk alongside thousands of patients and their families. I know that when you are facing a serious illness, you are looking for more than a service, you need a partner in care. 

Recent coverage, including reporting from the Los Angeles Times, has highlighted a difficult truth: while many hospice providers deliver exceptional care, quality varies and it’s not always easy to tell the difference. More than knowing the right questions to ask, it is important to understand what the answers actually mean. 

To ensure you or your loved one receives the compassionate, expert care they deserve, here is how to evaluate a provider — and how to interpret what you hear. Below are five questions that matter, and how to interpret the answers you get. 

Five Questions to Ask When Choosing Hospice Care 

1. How does the Interdisciplinary Team (IDT) work together? 

Hospice is unique because it treats the patient and their family as the “unit of care.” A high-quality hospice will have a tightly integrated team consisting of the patient’s primary care physician and/or treating specialist (like an Oncologist or Cardiologist), hospice medical director, nurses, social workers, spiritual care providers, home health aides, trained volunteers, and bereavement counselors. 

• Clinician’s Tip: Ask how often these different disciplines meet to discuss your specific care plan and what you can expect in terms of visit frequency by each member of the team. Data shows that while almost 90%+ of patients get nursing visits, social work and spiritual care participation can drop as low as 10-20%. By law, hospice is the only Medicare benefit that requires volunteers to provide at least 5% of total patient care hours– be sure to ask how those volunteers are integrated into family support and what they can actually provide. 

2. How are patients and families supported outside of scheduled visits and after-hours?

Crisis moments rarely happen during regular business hours. You need to know that expert help is available at 2:00 AM, not just 2:00 PM. 

• Clinician’s Tip: Ask if their on-call staff are hospice-certified employees of the agency or a third-party call center and confirm that they will make in-person visits no matter the day of the week or time of day. Hospice staff should be available 24 hours a day, seven days a week to assess the patient and provide care. 

3. What are your quality scores? 

Quality in hospice is measurable. Medicare tracks several metrics, including the Hospice Care Index (HCI) and the CAHPS® Hospice Survey, which measures family experience. 

• Clinician’s Tip: Be aware that only 29.5% of hospices have a public CAHPS star rating, often because they are too small to meet the survey requirements. If they don’t have a public rating, ask for their internal quality data regarding Hospice Visits in the Last Days of Life. 

4. Can you provide all four levels of care? 

A patient’s needs can change rapidly. The Medicare Hospice Benefit affords four levels of care to meet those clinical needs: Routine Home Care, Continuous Home Care, Inpatient Respite, and General Inpatient Care (GIP). 

• Clinician’s Tip: Ask specifically where their GIP care is provided. Is it in a dedicated hospice facility, local hospital, or skilled nursing facility? Knowing where your loved one will go if symptoms become too difficult to manage at home provides peace of mind. 

5. What support is available for the family after the loss? 

As a former social worker, I cannot overstate the importance of bereavement services. Hospice care does not end when the patient passes away. 

• Clinician’s Tip: The hospice benefit requires at least 13 months of bereavement support after death. Ask how this is provided—visits, support groups, or video calls—to ensure it matches what your family will need. 

Closing Thoughts 

Hospice focuses on caring, not curing. It is a model of care that honors the dignity of the individual and the strength of the family. By asking these clinical questions early, you ensure that your clinical partner is equipped to provide the expert medical, emotional, and spiritual support your family needs to navigate this journey together. 

Frequently Asked Questions About Choosing Hospice Care

When is the right time to choose hospice care? 

Hospice is appropriate when a patient has a serious illness and life expectancy may be six months or less if the disease follows its expected course. 

Who pays for hospice care? 

Hospice is typically covered by Medicare, Medicaid, and most private insurance plans, including services related to the terminal diagnosis. 

Can hospice care be provided at home? 

Yes. Most hospice care is delivered in the home, though services can also be provided in hospice facilities, hospitals, or skilled nursing settings depending upon patient needs. 

Can a patient leave hospice care if their condition improves? 

Yes. Patients can be discharged from hospice if their condition stabilizes or improves, and they can re-enroll later if needed. 

Alicia Bloom is Chief Operating Officer of Empassion, a national leader in serious illness and hospice care.