How to Choose a Hospice: A Family's Checklist

Choosing a hospice comes down to five things you can check in an afternoon: confirm it's Medicare-certified, read its family-survey ratings (and understand what a missing rating does and doesn't mean), note its ownership, ask whether it can provide inpatient care if symptoms get hard to manage at home, and — in California — verify the license yourself. This guide walks through each, in plain language, for a decision most families make in days.

You are likely reading this because a doctor used the word "hospice" recently, and you have less time than you'd like. Take a breath. Hospice is a benefit your loved one has earned, most of it is covered by Medicare, and you are allowed to be careful about who provides it. Careful does not mean slow — it means checking a few specific things.

First, confirm the hospice is Medicare-certified

A Medicare-certified hospice has been surveyed and approved to provide care under the Medicare hospice benefit. Certification is the floor, not the ceiling — but it's the first thing to confirm, because it's what makes the care covered and what subjects the hospice to federal oversight and inspection.

Every hospice in this directory is Medicare-certified; we build the site directly from the public Medicare provider data, updated each quarter. If a provider you're considering isn't listed here or on Medicare's Care Compare tool, ask them directly whether they are Medicare-certified, and get the answer before you enroll. A hospice that can't or won't confirm its certification is a hospice to set aside.

Certification also tells you the care follows a national standard: an interdisciplinary team, a required 24-hour on-call line, and coverage for the medications, equipment, and visits related to the terminal illness. You can read more about what that includes in what hospice provides and levels of hospice care.

Read the star ratings — and know what a missing rating means

Medicare publishes a star rating for many hospices, drawn from the CAHPS Hospice Survey. After a patient dies, the primary family caregiver may be sent a survey asking how the hospice did: Did the team communicate well? Did help come when it was needed, day or night? Was your family member treated with respect? Did you get support for pain, symptoms, and grief? Those answers are combined into an overall rating you can compare across hospices, according to CMS.

Two things are worth understanding about these ratings.

What they mean: the score reflects the experience of families who came before you. It's one of the few consumer-facing quality signals in hospice, and a consistently high rating across many surveys is a genuinely good sign — especially the "willing to recommend" and "getting timely help" measures, which families tell us matter most in a crisis.

The overall rating is built from a handful of measures you can also glance at individually on Medicare's Care Compare: communication with the family, getting timely help, treating the patient with respect, emotional and spiritual support, help for pain and symptoms, and training the family to care for the patient. If one of these matters more to your family than the summary score — say, timely help, because you're worried about nights and weekends — you're allowed to weigh it directly rather than the overall number.

What a missing rating does not mean: many hospices show no star rating at all, and that is not a red flag. Medicare only publishes a rating once a hospice has collected a minimum number of completed family surveys over the reporting period. A hospice can be new, small, or serve a community less likely to return a mailed survey — and still be excellent. In the current Medicare data, most hospices nationwide don't yet meet the survey threshold. When you see "Not enough survey data yet" on a profile here, read it literally: we don't have enough responses to show a rating, nothing more. Never let an absent rating stand in for a bad one.

If two hospices both serve your address and one has strong ratings while the other has none, the ratings are a reasonable tiebreaker — but they don't replace the questions below, and they never replace a phone call.

Look at who owns the hospice

Medicare records each hospice's ownership type — nonprofit, for-profit, or government — and we show it as a pill on every profile. This isn't a verdict. Excellent and struggling hospices exist in every ownership category, and you should judge any single provider on its ratings, its answers to your questions, and how it treats you on the phone.

Ownership is on the label because some families want to know, and because it's part of an honest picture. Federal regulators and the HHS Office of Inspector General have paid particular attention in recent years to rapid growth among newly enrolled for-profit hospices in a handful of states, and have flagged patterns worth a family's awareness. The takeaway isn't "avoid for-profits" — many are outstanding and long-established. The takeaway is: when a hospice is very new, aggressively marketed, or reluctant to answer plain questions, slow down and verify. Ownership type is one input into that judgment, not the whole of it. For a fuller comparison, see nonprofit vs. for-profit hospice.

Ask whether they can care for a crisis — inpatient availability

Most hospice care happens where your loved one lives, and that's the goal: comfort at home. But sometimes symptoms — pain, agitation, breathing trouble — can't be controlled at home, even with a good team. For those times, the Medicare hospice benefit includes general inpatient care: short-term, around-the-clock care in a facility until the crisis settles. It also includes respite care, a short inpatient stay that gives an exhausted family caregiver a few days to rest.

Not every hospice runs its own inpatient unit. Many arrange inpatient care through a contracted hospital or nursing facility instead. Neither arrangement is wrong — but you want to know the plan before a hard night, not during one. Ask directly: "If my mother's symptoms can't be managed at home, where would she go, how fast, and who arranges it?" A hospice that answers clearly and calmly is telling you something good about how it operates. You can read more in levels of hospice care and hospice at home.

In California: verify the license yourself

California hospices are licensed by the California Department of Public Health (CDPH), separately from Medicare certification. You can — and, given recent history in the state, should — confirm a California hospice's license yourself, for free, in about two minutes.

Go to the state's public Cal Health Find database, search for the hospice by name or city, and open its facility page. An active, licensed hospice will show a current license status. This is the state's own record, and it's the authoritative source — more current than any directory, including ours.

On California provider profiles, HospiceAtlas shows a green "Licensed — verified against CDPH" badge when we've matched a provider to an active state license, with a link to the source. It's worth understanding what that badge does and doesn't cover, which we explain in full on our methodology page: the badge is positive-only. Its presence means we matched an active license on a specific date; its absence means only that we couldn't confirm a match in the state's bulk data — not that a hospice is unlicensed. The bulk license file contains active licenses only. So for any California hospice, the state's Cal Health Find database is the check that settles it. When a license and a directory ever disagree, believe the state.

A calm, factual word about hospice fraud

You may have seen news about hospice fraud, concentrated in a few states, where operators enrolled people who weren't dying or billed for care that wasn't delivered. It's real, and it's the reason California paused issuing new hospice licenses and why federal oversight has tightened. It is also not the norm — the large majority of hospices are honest organizations doing hard, good work.

You don't need to be an investigator. You need three habits, and you already have them from this checklist:

1. Confirm Medicare certification (and, in California, the CDPH license) from the source, not from the hospice's own brochure.
2. Be wary of anyone who recruits a patient with gifts, cash, "free" services unrelated to a terminal illness, or pressure to sign up quickly. Legitimate hospices don't pay for referrals — it's illegal — and they don't rush a grieving family.
3. Ask the questions below and expect real answers. Evasiveness is information.

One more quiet signal lives on every profile: the Medicare certification date. A hospice certified twenty years ago has a track record; one certified last quarter may be perfectly good but hasn't built one yet. That's not a reason to walk away — every good hospice was new once — but in the handful of states where fraud has clustered, a very new provider is a reason to ask a few more of the questions below and to verify certification from the source before you enroll.

That's it. Verify from the source, decline anything that feels transactional, and trust that clear answers to plain questions are the strongest signal you'll get. Protecting your family here is not about fear; it's about checking the two or three things that are easy to check.

The short list of questions to ask

Before you decide, ask each hospice the same handful of questions and compare the answers side by side. We keep a printable version — grouped by theme, with a note on why each matters — in questions to ask a hospice. At a minimum:

• Coverage: Do you serve our ZIP code, and how soon can care start?
• Availability: Who answers the 24-hour line at 2 a.m. — a nurse, or an answering service that pages one? How fast can a nurse come to the house?
• The team: Who will we actually see, and how often? Will we have a consistent nurse?
• Crisis plan: If symptoms can't be managed at home, what happens, and where?
• Costs: What does Medicare cover, and is there anything we'd pay out of pocket? (For most families the answer is little or nothing — see does Medicare cover hospice and how much hospice costs.)
• Support after: What grief support do you offer the family, and for how long?

You are not being difficult by asking these. A good hospice welcomes them.

Start with the hospices that actually serve your home

The single most common mistake families make is calling a well-known hospice that turns out not to cover their address. A hospice's Medicare service area is the set of ZIP codes it covers, and it doesn't follow city lines. Start from where your loved one lives: enter your ZIP code on our homepage and you'll see every hospice whose Medicare service area includes your address, sorted by quality, with a call button. Then work down this checklist for the two or three that fit. That order — service area first, then quality, then a phone call — is how you choose well without losing days you don't have.