Understanding Hospice Care
What families should know
Hospice care is specialized medical care for patients with a terminal illness, focused on comfort and quality of life rather than curative treatment. With 7,011 Medicare-certified providers across 55 states, hospice is widely accessible, and Medicare covers virtually all costs. Over 95% of hospice care is delivered in the patient's home, allowing families to be together in familiar surroundings.
The hospice industry has grown significantly: 74% of providers (5,185) are now for-profit organizations, while 881 are non-profit and 77 are government-run. California leads the nation with 2426 providers. When choosing a hospice, families should look beyond ownership type to evaluate care quality, team composition, and family support services.
Medicare defines four levels of hospice care:
Routine Home Care: The most common level, with regular visits from nurses, aides, social workers, and chaplains in the patient's home for ongoing symptom management and support.
Continuous Home Care: Intensive nursing care for 8 to 24 hours per day during periods of crisis, keeping the patient comfortable at home when symptoms escalate.
Inpatient Respite Care: Up to 5 days of short-term inpatient care to give family caregivers a break while all hospice services continue.
General Inpatient Care: Facility-based care for pain control or symptom management that cannot be adequately addressed in the home setting.
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Choosing the Right Hospice Provider
Key factors to evaluate when selecting hospice care for your family
Quality of Care
Review quality measures including timely care initiation, pain management effectiveness, and family satisfaction scores from CMS CAHPS surveys. Providers with strong patient outcomes tend to have more experienced care teams.
Care Team Composition
A complete hospice team includes physicians, registered nurses, home health aides, social workers, chaplains, and bereavement counselors. Ask about staff-to-patient ratios and how quickly they can respond to urgent needs. Good providers offer 24/7 on-call availability.
Family Support Services
Look for comprehensive support including caregiver training, respite care to give you breaks, emotional counseling, and bereavement services. Medicare requires hospices to offer bereavement support for at least 13 months after a patient's death.
Care Settings
Confirm the hospice provides care wherever you need it: your home, a nursing facility, an assisted living community, or their own inpatient facility. Flexibility matters as needs may change over time.
Specialized Programs
Some hospices specialize in specific conditions like cancer, dementia, ALS, or pediatric care. Providers with disease-specific expertise often deliver better symptom management and more targeted family education.
Ownership & Accountability
With 74% of U.S. hospices being for-profit, ownership structure alone doesn't determine quality. Compare actual outcomes, ask for references, and check CMS quality data regardless of whether a provider is for-profit, non-profit, or government-run.
What Medicare Covers for Hospice
Medicare Part A covers virtually all costs related to your terminal illness
When you elect hospice care, Medicare covers all medically necessary services related to your terminal diagnosis. You pay nothing for most hospice services, though there may be a small copayment for outpatient prescription drugs (no more than $5 per drug) and 5% of the Medicare-approved amount for inpatient respite care.
To qualify, a doctor must certify that the patient has a terminal illness with a life expectancy of 6 months or less. Hospice can be renewed if needed, and patients may revoke hospice at any time to return to curative treatment.
Frequently Asked Questions
Common questions about hospice care
What is hospice care?
Hospice care is specialized medical care focused on providing comfort, pain management, and emotional support for patients with a terminal illness. Rather than trying to cure the disease, hospice focuses on quality of life for both the patient and their family.
Who is eligible for hospice care?
To qualify for hospice under Medicare, a doctor must certify that the patient has a terminal illness with a life expectancy of 6 months or less if the disease runs its normal course. Hospice care can be renewed if needed, and patients can leave hospice at any time.
What does Medicare cover for hospice?
Medicare covers virtually all hospice costs including doctor services, nursing care, medical equipment and supplies, prescription drugs for pain and symptom control, home health aide services, physical and occupational therapy, speech-language pathology, social worker services, dietary counseling, and grief counseling for the family.
How do I choose a hospice provider?
Consider the provider's care quality, team composition (nurses, aides, social workers, chaplains), response time for urgent needs (24/7 availability), family support services including bereavement counseling for at least 13 months, care settings flexibility (home, nursing facility, inpatient), and any specialized programs for specific conditions.
How many hospice providers are in the United States?
There are 7,011 Medicare-certified hospice providers across 55 states and territories. 74% are for-profit organizations and the remainder are non-profit, government, or other entities.
What are the four levels of hospice care?
Medicare defines four levels: Routine Home Care (regular visits at home), Continuous Home Care (8-24 hours of nursing during crisis), Inpatient Respite Care (up to 5 days in a facility to give caregivers a break), and General Inpatient Care (short-term facility care for pain or symptom management that cannot be handled at home).
Can hospice care be provided at home?
Yes. Most hospice care (over 95%) is delivered at home, including the patient's residence, an assisted living facility, or a nursing home. The hospice team visits regularly and is available 24/7 by phone for urgent needs.
What is the difference between hospice and palliative care?
Palliative care can begin at any stage of illness alongside curative treatment and focuses on symptom relief. Hospice is a specific type of palliative care for patients who have decided to stop curative treatment and have a prognosis of 6 months or less. Both prioritize comfort and quality of life.
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Data source: CMS Hospice Compare ·