As patients near the end of life with a terminal diagnosis, some may decided they will seek medical care only for comfort and not to cure an illness. Care for comfort, rather than a cure is hospice care.
[READ: How Do You Comfort a Dying Parent?]
What Is Hospice Care?
Hospice refers to a structure of medical care designed to keep patients comfortable without intentionally working to cure their ailments. It is offered to people nearing the end of their lives.
“The role of hospice is to help ensure the patient remains as comfortable as possible and their symptoms are managed through the end of their life,” says Corrie Bly, a registered nurse and the director of Home Health at AIM & Hospice Redlands Community Hospital in Redlands, California. “I like to focus on how to make the patient’s final days comfortable and a positive experience for them and their family. The patient and family know the expected outcome — we help them focus on how to have good days together.”
[READ What Is Palliative Care, and Can You Get It at Home?]
What are the four types of hospice care?
There are four types, or levels, of hospice care. Medicare-certified hospices are required to have all levels of hospice care as options for patients.
What services does a hospice provide, and who provides them?
Hospice providers don’t perform actions to speed up the dying process, but they don’t intervene with life-saving interventions to stop death from happening either.
Comfortable medical interventions can include:
— Pain management medication like morphine to ease symptoms
— Physical and occupational therapy services
— Social services
— Dietary counseling
— Spiritual or grief counseling services
Various staff workers on a hospice team provide these services. Some types of workers on a hospice team include:
— Physician, physician’s assistant or nurse practitioner
— Registered nurse
— Nursing aide
— Social worker
— Bereavement support person
— Chaplain or spiritual counselor
— Volunteers
Hospice providers don’t typically offer 24/7 support or serve as home health aides, but they may be available for unplanned emergencies.
Dr. Brian D. Madden, a primary care physician and the medical director of palliative care at Providence Saint John’s Health Center in Santa Monica, California, says that hospice care tends to meld into a person’s life during their final days, months or years — because some hospice patients live much longer than expected.
In most cases, hospice “can enable patients to remain at home, focusing on living or, when inevitable, dying with comfort,” Madden adds.
[Read: What to Do When You Become the Family Caregiver]
Are You or a Loved One Ready for Hospice? Ask Yourself These Questions
To know if you or a loved one is ready for hospice, take some time to think through the state of your/their health and the gravity of your/their decision.
Here are some questions to ask:
Do you or your loved one have a terminal illness and you qualify for hospice care covered by insurance?
To be eligible for hospice, you have to be experiencing a terminal condition. The Medicare Hospice Benefit, which is accepted by many hospice providers in the U.S., covers hospice care for people who are certified as having six months or less to live by a medical doctor. However, people can be on hospice for longer than this.
Are you prepared for you (or your loved one) to pass away?
It’s important to emotionally prepare for the outcome of dying. Being in hospice means that your provider will not provide life-saving interventions in crisis, which can be hard for some patients and loved ones to come to terms with. Madden encourages people to talk about potential outcomes and not to shy away from conversations about death.
“Talking about hospice is a discussion about dying,” Madden says. He adds it can be productive for providers to help “patients and families understand that hospice, while not trying to hasten death, does not avoid it when the clinical scenario deteriorates.”
Are you clear on the expectations of hospice?
When discussing the possibility of hospice, Madden encourages patients and families to ask themselves whether they are focused on a goal of allowing death in the first place.
“Sometimes the expectations are that hospice will be checking labs, providing IVs, which is typically not the case,” Madden says. “While every circumstance is different, being ready to discuss tradeoffs and priorities is crucial. Is it more important to stay at home or stay alive longer but risk dying in the hospital? This is often a very important question.”
Are you ready to accept comfort care rather than a cure?
In addition to certifying that you are terminally ill, Medicare requires you to accept comfort care (palliative care) instead of care to cure your illness, and sign a statement affirming your decision to undergo hospice care.
[SEE: How to Pay for Nursing Homes With Hospice Care: Payment Options]
How Hospice Helps Patients Prepare for Death
In addition to offering medical assistance, hospice providers can help you and your loved one practically and emotionally prepare for death. Practically, they can help you establish end-of-life plans, and emotionally, they can offer bereavement services for patients and families.
How do hospice providers help with end-of-life plans?
Hospice providers can help your loved one create end-of-life plans, like advance directives and documentation regarding your loved one’s medical preferences.
“Hospice professionals are experts in facilitating conversations around end-of-life plans and advance directives,” says Dr. Sonia Sehgal, chief of geriatric Medicine at UCI Health. “They encourage conversations with patients, families and the medical care team to align the patient’s values and decisions and make them actionable. Hospice social workers, chaplains and nurses facilitate these conversations.”
Laury Bliss, the executive director of MemorialCare Hospice in Fountain Valley, California, adds that hospice workers can help you and your loved one understand the end-of-life options out there, and ensure that your loved ones’ “wishes are clearly documented.”
“The hospice team works closely with patients and families to develop a comprehensive end-of-life plan that aligns with the patient’s values and goals,” Bliss says.
How do hospice providers help families cope with bereavement?
Hospice workers, such as spiritual coordinators and social workers, can be key players in helping you and your loved ones cope with grief or other difficult emotions you are experiencing while your loved one undergoes hospice. Bliss says community support groups comprised of other people going through similar scenarios may also be helpful during this time.
If you are going through bereavement, Sehgal says to remember that your feelings are valid, and encourages leaning on social supports and medical professionals for help.
“It is normal to feel sadness, anger and anxiety,” Sehgal says. “Staying present can help family members to focus on the time they have with their loved one.”
She adds that talking through emotions with friends and family can be healing for some people, but is not the only solution. “If feeling overwhelmed, therapists are uniquely positioned to help manage emotions and provide support,” Sehgal says.
[SEE: Advance Directives: Your Complete Guide to Living Wills & Health Care Power of Attorney]
How to Choose a Hospice Provider
After deciding you’re ready to pursue hospice, you’ll want to be thoughtful about which provider you choose. And there are many to choose from. According to the most recent data from the Centers for Disease Control and Prevention, there were 5,200 hospice care agencies and 1.5 million hospice patients in the United States in 2020.
Questions to Ask Hospice Providers
1. Is this hospice regulated and Medicare-certified?
Hospices that are regulated and Medicare-certified are hospices that offers (at least) the basic services covered by Medicare
.
Hospice plans should cover the following basic services:
— Doctor, nursing and medical services
— Durable medical equipment for pain relief and symptom management
— Medical supplies, like bandages or catheters
— Drugs for pain and symptom management
— Short-term inpatient care for pain and symptom management
— Support services such as social services, physical and occupational therapy, speech-language pathology and aide and homemaker services
— Dietary counseling
— Spiritual and grief counseling for you and your family
— Inpatient respite care, up to five days at a time
Depending on your individual care requirements, you may or may not be given all of these services. Additionally, your hospice team may recommend other services that Medicare covers to manage your pain or symptoms related to a terminal illness or related condition.
2. What is this hospice’s Medicare star rating?
The hospice’s Centers for Medicare & Medicaid Services star rating is a one- to five-star rating on the quality of the hospice’s services. A five-star rating is the highest rating.
These ratings are based on a monthly survey from the Consumer Assessment of Healthcare Providers and Systems, or CAHPS. The CAHPS’s hospice survey collects information from family caregivers and hospice patients about their thoughts on the hospice care provided. It also includes information on six measures of care.
The six measures of hospice care include views on the hospice’s quality of:
— Communication with family
— Providing timely help
— Treating patients with respect
— Emotional and spiritual support
— Helping with pain and symptoms
— Training family to care for patient
The survey also asks survey participants to include:
— Rating of the hospice
— Willingness to recommend the hospice
3. Is this hospice connected to a larger hospital or medical system?
Some hospices are stand-alone agencies, while others are connected to larger institutions, like hospitals
. Hospices that are connected to hospitals may be able to offer you extra support.
Madden says it’s typically a good thing if a hospice integrates with an existing medical system or hospital, so information can be conveyed easily from the prior team to hospice. However, some stand-alone hospices can be shining stars too.
4. Does this hospice have a good reputation in its area?
While reputations aren’t everything, learning about other people’s interactions with hospice providers can give you intel on how the same hospice providers might interact with you or your loved one.
Bly recommends reading “reviews from other families to get an understanding of how well the program supported them.” You can also check out reviews on websites like Nextdoor (a social app for neighborhoods, where you can get local tips and recommendations), Madden adds.
5. Is the hospice staff respectful?
Hospice staff will be with your loved one during a critical time in their lives, and yours as well. With that in mind, you’ll likely want to work with a group that treats you both with respect.
You may also be able to get a sense of the staff’s attitude at a hospice by checking ratings, talking to people you know and reading reviews.
You may also be able to feel this out by talking to representatives on the phone. However, this is not always the case, and the person you talk to on the phone is not usually part of the care team. Madden says that because of hospice’s entanglement with insurance providers, the person you talk to on the phone to sign up with is unlikely the person who will be providing care to you.
“It can be an unfortunate experience, but these people are not the clinical staff who will ultimately be providing the care, and it is important to consider that,” he adds.
If the hospice is associated with a general inpatient unit, it may also be possible to visit beforehand. However, rules can vary from place to place, and not all hospice services are attached to a physical location, so site visits are not always possible, Bly says.
6. Does this hospice offer culturally appropriate care?
Not all cultures view respect in the same way. It can be meaningful to work with a hospice provider that knows and respects your loved one’s cultural values and provides them with culturally appropriate care.
To ensure that your hospice provider can offer your loved one the culturally appropriate care they desire, Sehgal recommends to “directly ask hospice care providers specific questions about their policies and experiences with diverse traditions and beliefs.”
“Families should feel comfortable approaching this and advocating for their loved ones,” she adds.
Some examples of culturally appropriate care include:
— Available interpreter services
— Available translations of written material
— Accepting environments
— Environments aligned with patients’ beliefs
— Allowing patients to use, keep or bring (depending on the location of services) items and materials aligned with their beliefs
— Available spiritual supports tailored to the patient’s or family’s beliefs, such as special prayers, silent periods or food items
7. Are hospice staff competent?
To check if your hospice staff is competent in caring for your loved one’s specific needs, be sure to ask questions, check staff credentials and read reviews about their services.
8. How long is your commute to a hospice program or your providers’ commute to you?
Unlike a hospital, hospice is not a “location,” nor a 24-hour residential support program. Instead, hospice can be provided through several means, such as programs at a hospital, nursing home
or assisted living facilities or in a person’s home.
Whatever the case, keeping a close distance between you and your care team can shorten commute times and increase your loved one’s access to quick care when needed. As a supporter, being close to a loved one’s hospice team can make it easier for you to visit.
9. Is this hospice experiencing any staffing issues or shortages?
A hospice that is short-staffed may be less capable of responding to your needs and emergencies than one that is well-staffed. But what qualifies, or quantifies, as well-staffed can vary per agency.
“Hospice does not have staffing ratios like a hospital would, so there is no published benchmark to compare to,” Bly says.
She adds that hospice nurses may be able to take on more cases in urban settings, where patients live closer together, than in rural settings where people live farther apart.
Rather than play a numbers game, she says a good way to understand if a hospice has enough staff to meet patients’ needs is to ask questions like:
— What is the hospice’s response time to their farthest service area?
— How long does it take a patient to get help during the day?
— How long does it take a patient to get help at night, on the weekends or holidays?
— What is the average caseload for an RN case manager?
— Are the daytime nurses on call after hours, or does the hospice assign separate after-hours shifts?
10. Are hospice providers capable of making unscheduled visits?
Unscheduled hospice visits can be necessary during emergency scenarios.
In a preliminary conversation, Madden suggests asking a provider, “What would you do if there was an urgent issue?”
You should feel confident in the triage process and their capacity to make unscheduled visits.
11. What kinds of ancillary services does this hospice offer?
Some hospices offer non-medical, or ancillary services like art or music therapy, pet visits and acupuncture. These can be appealing to some patients and may help patients and loved ones cope with the emotional challenges of hospice.
Some ancillary services hospices may provide include:
— Acupuncture
— Aromatherapy
— Massage
— Music therapy
— Pet therapy
— Virtual reality
— Guided imagery
— Cognitive behavioral therapy
— Mindfulness practices
— Meditation
Bliss says she notices that some patients find music therapy and pet therapy beneficial in hospice care. “Both can provide a sense of well-being, relaxation, reduce anxiety and improve mood.” She adds that while “ancillary services can be integrated into hospice care as part of comfort measures,” it is also “essential to ensure that these services are medically suitable and provide comfort to the patient.”
Data also supports the use of some of these services, such as music therapy and acupuncture, Sehgal says.
“Music therapy reduces anxiety and stress, aids in the management of pain and supports caregivers — overall, it improves quality of life,” Sehgal adds. “Acupuncture may relieve pain and shortness of breath. It appears to be a promising adjunct to symptom management at the end of life.”
While benefits may abound it is important not to choose a hospice based solely on their ancillary offerings, either. Madden warns to be wary of hospices that offer material benefits — like promises of flat-screen TVs and additional medical supplies — as these can be “fraud abounding.”
In recent years, some hospices have been exposed as using material benefits to lure people into hospice, even if they had more than six months to live. In California, where Madden is based, he says that loose regulations on hospice care “have led to an increase in the number of hospice agencies and unscrupulous providers” offering hospice care.
2026 Alert: How to Spot Hospice Fraud
Hospice red flags to watch for:
Marketing and enrollment red flags
— Unsolicited door-to-door visits: Typically, hospice care starts with referral from a primary care physician. Exercise caution with any hospice representatives who contact you without prior referral.
— Offers of “free” gifts: It is illegal for a hospice to provide gifts of any kind in exchange for enrolling.
— The “free benefit” pitch: Scammers try to misrepresent hospice as a “free extra benefit” for anyone over 65 and fail to mention that enrolling requires you to give up curative treatments (like chemotherapy or dialysis).
— High-pressure signing: Before enrolling in hospice, patients should consult with their physician or medical provider, along with family members or a close friend. If a hospice representative pressures you to sign enrollment forms “on the spot” without further review or consideration, walk away.
Clinical and operational red flags
— Patient has not received a terminal diagnosis: If there’s not a clear terminal diagnosis but a patient is being pushed into a hospice, this could be a scheme to bill Medicare for a patient that does not truly meet eligibility requirements.
— Staff or provider “ghosting”: You should able to reach the provider and see staff or nurses aides regularly, including weekends and holidays. If this is not the case, this may be a “paper hospice” that bills for visits not conducted.
— Lack of physician involvement: In 2026, “face-to-face” attestations are required by Medicare. If an in-person meeting with a doctor or nurse practitioner for your recertification doesn’t occur, the provider is not in compliance with Medicare regulations.
— Long stays without updates: In general, a hospice patient is certified for six months. If the patient remains in hospice for years with no signs of decline or discussions of a “live discharge,” this could be a sign the hospice provider is warehousing patients to bill Medicare.
How to verify a hospice provider
Before signing anything, take these three steps to protect your loved one:
1. Check the Centers for Medicare and Medicaid Services hospice oversight data: Ensure the provider isn’t on the CMS “Enhanced Oversight” list (currently targeting high-fraud areas in CA, TX, AZ, NV, GA and OH).
2. Verify the address: Legitimate hospice providers should have a physical clinic headquarters as a business address, not a “virtual office” or a residential home as the listed business address.
3. Confirm with your primary doctor: Do not enroll in hospice without first having a conversation with the doctor overseeing the patient’s chronic illness.
If you suspect a hospice scam, call the Office of Inspector General Hotline at 1-800-HHS-TIPS or contact your local Senior Medicare Patrol. Senior Medicare Patrol is a nonprofit that empowers and assists Medicare beneficiaries, their families and caregivers to prevent, detect and report health care fraud, errors and abuse through outreach, counseling and education.
Does Medicare Cover Hospice?
Yes, Medicare does provide hospice coverage. Here is an overview of what hospice services are covered by Medicare. Of note, while Medicare covers 100% of these services, it generally does not cover room and board if the patient lives in a nursing home or at home.
Consider Your Loved One’s Unique Needs
Bly recommends taking time to write down some questions of your own — and thinking about your goals. Do the providers you are looking at offer services that align with your goals?
“Learning that a loved one needs hospice care can be overwhelming,” Bly says. “It’s important that the hospice provider be knowledgeable, flexible and calm. It’s also important for the hospice provider to be an active listener and include the patient and family in planning the patient’s care.”
You can also use the Medicare Compare Tool to find hospice agencies in your area and receive information on different agencies’ quality and reviews.
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originally appeared on usnews.com
