How to Choose a Hospice Provider – A Very Important Decision

There are more than 5,000 hospice agencies providing their services spanning across the country, and choosing the right hospice agency can feel a bit overwhelming.  

It is quite common that a doctor will simply refer a patient directly to a particular hospice agency without presenting their patients with any options. I can imagine that when a doctor sits down and tells someone…”There is nothing more I can do for you, and now I am referring you to hospice.” Most people are initially in a state of shock.  It can be a comforting thought that the doctor and the hospice agency have this symbiotic relationship of trust and everyone only wants what is in the best interest of their patients.

While still in a bit of a mental fog, now there is a barrage of strangers coming into your home with the intention of providing a “service” to you.  These patients don’t realize that their doctor has really removed themselves from their care, in majority of the cases, and now a faceless doctor is charge.  The hospice team becomes their primary access to healthcare, and essentially a very important lifeline.

Let it be known…. Medicare  has declared that patients have rights when it pertains to their medical care, and the hospice agencies are required to comply with the established Conditions of Participation.

Choosing a hospice agency is a big decision! It is strongly encouraged that anyone considering hospice care meet with representatives from a few different hospice agencies before making a selection.  Chances are very good that any hospice agency would be very willing to talk to you and sell their service.  Some of the larger hospice agencies spend a lot of money and manpower with aggressive marketing strategies. Hospice agencies are motivated to make a profit and there is a lot of competition within the market.

There are a several factors to consider when interviewing hospice agencies, and one of them might be the size of the agency.  Some hospice agencies are locally owned and tend to operate on a the smaller scale, while other agencies are part of a large corporate chain.  One way to measure the size of the organization is by asking  the Marketing Representative how many patients they have on their hospice service.  This number is referred to as their “census”, and can range anywhere from a few patients to several hundred.

Another consideration would be questions about the nursing staff and how they deliver care.  It is perfectly acceptable to ask the Hospice Marketing Representative about the caregivers that are employed to provide care.  It would be valuable to know how many patients each nurse is expected to take care of at one time. Typically the Nurse Case Manager should only be expected to oversee the care of 12-14 patients on average. The expectation of the nurses that are working in providing hospice service to nursing home residents may differ slightly, since there is a possibility of having multiple patients in on location.  But I have been witness to  hospice agencies that expect their nurses to manage over 20 patients at one time! This is dangerous and often leads to service failure.

Listen to your instincts, and beware of a Hospice Representative that either hesitates or is unable to answer your questions all together.    When interviewing hospice agencies,  don’t be afraid to ask a lot of questions. The National Hospice and Palliative Care Organization also has a nice handout with some more questions to be considered when choosing a hospice agency.

Every hospice agency must have all of the elements of a hospice team in order to be eligible for Medicare reimbursements. Each member of the team has a specific role in providing hospice care.


This your Doctor for Hospice Services,  and is it rare that you will ever meet this individual. When a patient has a need that goes beyond the scope of the Nurse, it is acceptable for a Nurse Practitioner see the patient in their environment. The Doctor is generally a part-time Hospice Practitioner and is expected to oversee between 40-60 patients. Medicare does requires that the entire team sits down together for a team meeting every 14 days, and the Medical Director is always present. The Hospice Nurse is in close communication with your Hospice Medical Director, the physician is responsible for providing all the orders and directions for all the aspects of your care.


Medicare and Hospice Requirements state that the Case Manager are the coordinators of direct patient care and must be a licensed Registered Nurse.  Seasoned hospice nurses may also be further credentialed as a Certified Hospice Palliative Nurse.  Some agencies will all employ Licensed Vocational Nurses or Licensed Practical Nurses,  usually the corporate larger agencies,  to handle unexpected visits and support unstable staff.   These types of nurses can only work under the supervision of a Registered Nurse.


Usually the most loved by the patients and families! Medicare requires that the Hospice Aide be a Certified Nursing Assistant and they will provide care usually between 2-5 times per week, depending on the level of need. Usually their visit lasts from 30 minutes to an hour, and the primary focus hygiene aka personal care. The RN Case Manager will work very closely with the CNA through frequent communication and the Medicare requirement of a supervisory visit every 14 days.


This particular caregiver is an extremely valuable person on the team. Medicare requires that a social worker evaluate a newly admitted patient within the first 5 days of service. Questions about Medicare, Medicaid, FMLA, Advance Directives, and Funeral Arrangements are only some of the topics that they will address. The Social Worker also provides emotional support to the patient and the family typically conducting visits on a monthly basis and as needed.


These caregivers are usually non-denominational spiritual counselors.  Chaplains are specially trained in working with patients and families at the end of life to provide support. The Hospice Chaplain is very careful to be  respectful of differing cultural beliefs and religious practices.


Hospice will continue to provide emotional support to the families who have lost a loved one for a full year through a Bereavement Program. Grieving is a process and takes times.  The Bereavement Counselor with maintain regular contact with the family members after their loved one passes away and provide counseling and resources.


These generous individuals are specially trained to provide emotional support and spend time sitting with patients dependent to their need.   Medicare does require that Hospice Agencies utilize and offer volunteer services to their patients on a regular and consistent basis.

I  hope that you found this information useful, and it helped to provide some clarity on finding the right hospice for you or loved one.  There is no one else that will advocate for your loved one like you do.  Please feel free to ask a question or leave a comment.


  • lynnsamuelson April 4, 2017 at 8:08 pm

    No one ever wants to have to think about hospice, much like life insurance. Yet we all know that we’ll eventually die at some point and my view is that we should try and learn about this before calamity strikes. Too often it’s the family members who need to make these choices for their loved ones who are too frail or distraught to make their own decisions.
    My only experience with hospice care was with my mother-in-law and she received excellent care from a smaller agency. My mother is 86 and healthy now but I’m preparing myself just in case.
    I’m curious about the cost of hospice care and whether it differs with the smaller and larger agencies.

  • Heather Williams RN CHPN April 5, 2017 at 2:03 am

    Hi Lynn,
    Most patients have Medicare, and there is no out of pocket cost with the Medicare benefit, as they pay 100% of all costs related to hospice care. Private insurance may have some deductibles that need to be met, but there really should not be any itemized costs to the patient at all. All agencies should operate in the same way, the size of the agency does not have all that much bearing. I hope that is helpful. 🙂
    Many Blessings,

  • Attila April 5, 2017 at 10:17 am


    “The hospice” in first place it is scary word because it is an unavoidable phase in our modern society. The price that we pay for privacy and luxury neglecting our family. This site depicts very well this turnig point in the life of a patient and the family too. It is the last phase of your life and than you die ! Good advice and a gentle approach is crucial ! The structural analysis of a hospice is very important when you have to choose, and this site gives a good advice.I think that a good choice makes the difference between “”LIVING LONGER”” and””DYING LONGER””

    It was a pleasure to read how this site guides people trough a crucial phase of their lives !



    • Heather Williams RN CHPN April 5, 2017 at 1:10 pm

      Thank you for taking the time. Hospice can be a scary word, my mission to dilute some of that fear and reinstill a sense of hope. Take Care, Heather

  • ches May 1, 2017 at 11:46 am

    Such an informative article, thanks for doing this post.
    We have last week, managed to get our beloved family member into a hospice.
    You’re, right the experience was somewhat overwhelming and whilst already dealing with the upset of a very sick relative who is suffering in hospital, the added stress of trying to get him out and into a better place was added pressure for him and the family.
    In the end, we contacted ‘Macmillan Nurses’ a popular UK agency, who took all the stress away and got our loved one into a wonderful hospice. What a difference it made to the patient and all those family members who wanted to visit him.
    The hospice environment is so different to a hospital. No hustle and bustle with everyone doing all they can to help the family and loved one. All medication was taken care of and he has his own room with a TV and en suite facilities. His care is paramount to the nurses and anything he wants, they get immediately. It is so peaceful and relaxing for all involved. Ches

    • Heather Williams RN CHPN May 3, 2017 at 11:38 am

      Hi Ches,
      Thank you for the update. I know the last few weeks have been stressful for you and your loved one. I am relieved that your family member is getting the care needed in an warm and supportive environment. Comfort is the priority in hospice, and the organizations that provide service should be a help to the family and decrease the stress. Many Blessings!
      Take Care,


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