How to choose a hospice: Questions to ask to get the care you want

What is hospice?

Hospice is a specialized type of care that provides holistic, compassionate, and personalized support at the end of life. Physicians, nurses, social workers, chaplains, healthcare aides, and trained volunteers are available to support individuals in hospice.

The goal of hospice is to maintain or improve quality of life by addressing the physical, social, emotional, and spiritual needs of people who are in the terminal phase of an illness and are no longer seeking life-prolonging treatment. Hospice also offers support for caregivers and loved ones, including grief support after death.

Hospice enrollment requires certification that the patient has a terminal illness and a life expectancy of six months or less, and it is the hospice’s responsibility to verify that. A doctor can refer someone to hospice, but it is not a required first step.

That said, at any point in your care journey, you can begin learning more about hospice, discussing this option with your provider, exploring what hospices exist in your area, and seeing what options are available to you based on your insurance coverage.

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Your hospice care team will play a vital role in the last months and days of life, helping you make the most of precious time. It’s important to interview and choose a hospice provider that is a good fit: one that respects your priorities, identity, and beliefs, and that will honor your end-of-life care choices.

Finding a hospice

All Medicare-certified hospice providers are required to provide a standard set of services, but there are variations in how they provide that care and what additional support they offer. For example, some may offer massage and pet therapy programs. Some may support the full range of end-of-life care options, such as voluntary stopping eating and drinking (VSED) and medical aid in dying (where authorized), while others may not.

You can begin learning about hospices in your area by asking others who have experience with hospice for advice. Your clinician may also have a particular hospice they prefer; ask them for more details. Some private insurers are contracted and will only pay for a particular hospice, so ask your insurance for a list of covered options.

Search for hospices near you at NationalHospiceLocator.com. Additional information can be found at Medicare.gov and CaringInfo.org.

Interviewing a hospice: Questions to ask

Once you’ve found a hospice you are interested in, call and ask to speak to an intake person or request an in-person meeting. Be ready to take notes. Explain your current medical situation, tell them where you live, and ask questions from the list below that are important to you. You can also request an evaluation to determine whether you are eligible for hospice.

Listen for concern, kindness, and thoughtful responses. Remember, it’s important to choose a hospice that is the best possible fit for you.

General patient care

How long has your hospice organization been in business? How long have you been certified by Medicare?
What is the role of my healthcare provider once hospice care begins? Can I still see them if I want to?
How will the hospice physician oversee my care and work with my primary provider?
How are my family and caregivers given the information and training they need to care for me at home?
What happens if my care cannot be managed at home?
How does the hospice provide services for people in different settings such as nursing homes or other residential care?
How will the hospice staff work with me, my loved ones, and caregivers to honor my wishes?
What services and support do volunteers provide? (Often hospice volunteers offer massage, reiki, or group therapies.)

Pain management and comfort care

Will the hospice staff regularly discuss and routinely evaluate pain control and symptom management with me, my loved ones, and caregivers?
How quickly does the hospice staff respond to requests for additional pain medication? What is the process?
How will hospice meet my spiritual and emotional needs as well as those of my loved ones and caregivers?
Is respite care (relief for caregivers) available?
What bereavement services are available for my loved ones after I die?
How does the hospice provide services for people in different settings such as nursing homes or other residential care?
How will the hospice staff work with me, my loved ones, and caregivers to honor my wishes?

My end-of-life care options

Does the hospice and care facility have policies around voluntarily stop eating and drinking (VSED) or ways to support a patient’s choice to stop or minimize eating and drinking?
What is the policy on medical aid in dying (in authorized states)?
If I decide to request aid-in-dying medication, will I be able to take it while in your hospice program? How will hospice support me and my loved ones in that process?

After-hours care

How does the hospice provide 24-hour support? Who answers calls on nights and weekends; will it be your staff or an answering service?
How quickly do hospice staff respond to after-hour calls and emergencies?
Are chaplains and social workers also available after hours?
How are calls and visits handled when death occurs?

Paying for hospice care

If I am not on Medicare or Medicaid, will all hospice-care costs be covered by my health insurance?
Are there any services that have to be paid for out of pocket? Are any provided at no charge?

Community, equity, and access

What trainings has your staff undergone to ensure compassionate care is provided to all patients and families, including those with diverse backgrounds and identities?
Has your organization earned any specific certifications for inclusive care?
What are your policies and protections for Black, Latino, Asian American, Native Hawaiian, Pacific Islander, Indigenous, LGBTQ+ individuals, and diverse bodies, considering potential discrimination by staff, volunteers, or others seeking care?
What ways does your hospice uplift, care for, and accommodate people in bigger bodies? Do any care options or medical equipment provided have weight limitations?
How is gender-affirming care provided? How does the hospice ensure my pronouns, gender identity, and chosen family are respected by my care team?
How does your chaplaincy or spiritual care team support patients who are non-religious, atheist, or belong to minority faith traditions?
If my cultural identity or religious tradition requires specific rituals at the time of death, how will the staff accommodate and honor them?
Does your hospice offer services for clients that speak little or no English? Is there a translator always available or upon request in specific circumstances?
If I encounter a staff member or volunteer who is judgmental or insensitive, what is the process for reporting this and requesting a change in my care team?
How does the hospice provide care when there are concerns about a patient’s safety, financial hardship, or lack of caregiver support?
Does the hospice have experience working with patients who may have experienced medical trauma or have a deep-seated mistrust of healthcare institutions?

Additional information

What is unique or special about your hospice organization?
Is there anything else you can tell me about the services hospice can offer to support me at the end of my life?
Is there anything else I should know or prepare for?

Making the decision

After completing your research and interviews, compare notes. As you evaluate options, you can seek input from someone you trust. Do not hesitate to call a hospice back for clarification or go visit again in-person if you have lingering questions.

Your hospice team will play a significant role in the last months and days of your life, so you want to feel confident that you will be treated competently, respectfully, and compassionately, and that your end-of-life wishes will be honored.