20 Questions to Ask Before Choosing a Hospice

The best way to choose a hospice is to ask every provider the same pointed questions — about after-hours response, staffing, crisis care, costs, and quality scores — and compare the answers side by side. Below are 20 questions grouped by topic. Bring them to each phone call or intake meeting and write down the responses so you can compare fairly.

You will not always get to ask all 20 — sometimes a hospice is needed within hours. In that case, focus on the night-response and cost questions first; those have the biggest impact on a family's actual experience. When there is more time, the full list lets you see meaningful differences between providers that all look similar on paper.

Availability and response (the night test)

• 1. Is your on-call line answered by a nurse 24/7, and how fast can a nurse come to the home at night or on a weekend?
• 2. Who responds after hours — your own staff or an answering service?
• 3. How do you handle a symptom crisis — Continuous Home Care at home, or moving to a facility for General Inpatient Care?
• 4. Do you visit on weekends and holidays?

For why this matters most, see questions to ask about after-hours support and does hospice provide 24/7 care.

Team and visits

• 5. How often will the nurse, aide, social worker, and chaplain visit, and does that increase as needs change?
• 6. Will we have a consistent team, or rotating staff?
• 7. What is your nurse-to-patient ratio?
• 8. Can the patient keep their own doctor alongside your hospice physician?
• 9. What does the aide do — and is it intermittent help, not 24-hour care?

Care settings and crisis options

• 10. Do you provide all four levels of care — routine, continuous, GIP, and respite?
• 11. Where do you provide GIP and respite — your own inpatient unit, a hospital, or a nursing facility?
• 12. Can you serve the patient where they live (home, nursing home, assisted living)?

Costs and coverage

• 13. What will we owe out of pocket — do you waive the up-to-$5 drug copay, and how is the 5% respite coinsurance handled?
• 14. What does and does not get covered for our specific situation, in writing?
• 15. If the patient lives in a facility, who pays room and board? See hospice room and board: who pays.
• 16. Will you admit while a Medicaid application is pending, and do you offer charity care?

Quality, accreditation, and trust

• 17. What are your CMS Care Compare quality and family-survey (CAHPS) scores? See how to read CAHPS scores.
• 18. Are you Medicare-certified and accredited?
• 19. How long have you operated, and are you nonprofit or for-profit?
• 20. How do you handle complaints, and how can we switch hospices if we are unhappy?

How to score the answers

Twenty answers can blur together, so give each provider a simple grade on the handful of factors that change daily life. A practical scoring sheet covers five lines: night response (how fast a real nurse arrives), staffing consistency, honesty about costs in writing, crisis capability (do they offer continuous home care and general inpatient care), and family-survey scores. Mark each provider strong, adequate, or weak on those five. A hospice that is strong on night response and cost transparency but average on everything else will usually serve a family better than one that looks polished on paper but cannot give a clear 2 a.m. answer. Resist the pull to choose on a single feature, such as a nice inpatient building, when the patient will spend almost all of their time at home.

What good answers sound like vs. warning signs

Question area	A reassuring answer	A warning sign
After-hours line	"A nurse answers, and we can have one at your home within a set time."	"An answering service takes a message and someone calls back."
Crisis care	"We provide continuous home care and arrange general inpatient care when needed."	Vague or no mention of the four levels of care.
Costs	"Here is what you owe, in writing, for your exact situation."	"Don't worry, it's all free" with nothing in writing.
Quality	Shares Care Compare and CAHPS scores readily.	Cannot or will not discuss public scores.
Complaints	Explains the grievance process and how to switch.	Defensive, or pressures you to sign quickly.

Tailor the list to your situation

The 20 questions are a baseline; add a few that match your circumstances. If your loved one lives in a nursing home, press hard on question 15 about who pays the room and how the hospice coordinates with facility staff. If you need bilingual care, ask whether staff or no-cost professional interpreters are available. If the patient lives alone, ask specifically what the safety plan is for the hours no clinician is present. If you are a veteran, ask how the hospice works with VA benefits. Matching the questions to your reality is what turns a generic checklist into a decision tool.

The misconception, corrected

Families often assume all Medicare-certified hospices deliver the same experience, so they pick the first name a hospital hands them. Certification sets a floor, not a ceiling — responsiveness at 2 a.m., staffing levels, and family-satisfaction scores vary a great deal between agencies. Asking identical questions and comparing answers is how you see those differences. Watch for vague or evasive responses, which can be a warning sign; see red flags: how to spot a low-quality hospice.

Pay attention not just to the answers but to how they are given. A good hospice welcomes hard questions about staffing, costs, and complaints, and answers them plainly and in writing. A provider that dodges the cost question, cannot give a clear night-response time, or pressures you to sign quickly is telling you something important. Your willingness to ask is not rude — it is exactly the diligence a serious provider expects from an informed family.

Frequently asked questions

How many hospices should I actually call?

Two or three is usually enough to reveal real differences without exhausting you in a stressful time. If your hospital handed you one name, call at least one more so you have a comparison. Even a single extra call often surfaces a better night-response time or clearer cost answer.

Is a free-standing inpatient unit a sign of higher quality?

Not by itself. An inpatient unit is useful for short crisis (general inpatient) and respite stays, but most hospice care happens at home, so day-to-day responsiveness and staffing matter far more than the building. Weigh the unit as one feature, not the deciding factor.

Should I worry about for-profit vs. nonprofit status?

Ownership is worth knowing but is not destiny; there are excellent and poor providers in both categories. Use the public quality and family-survey scores and your own interview answers as the real evidence rather than the tax status alone.

Can I switch if the first hospice isn't working out?

Yes. You can change hospices once per benefit period with no penalty, and a good provider will explain that process if you ask question 20. Knowing you are not locked in lowers the pressure of the initial choice.

How fast can a hospice admit my loved one?

Many hospices can complete an admission within a day, and some offer same-day admission in urgent situations. If timing is tight, ask each provider directly how quickly they can send a nurse to evaluate and start care, and weigh that speed alongside their night-response and cost answers.

Practical next steps

• Call at least two or three hospices and ask the same questions.
• Pull their Care Compare scores before or during the calls.
• Get costs and coverage in writing for your exact living situation.
• Use a structured process — see how to choose a hospice provider — and compare Medicare-certified hospices in your area.

Bottom line: a short, consistent list of questions turns a stressful choice into a clear comparison. Prioritize after-hours responsiveness, honest cost answers, and strong family-survey scores.