Quick Answer: How to Know a Hospice is Legitimate and Good
To know a hospice is legitimate and good, start by checking for red flags like door-to-door recruiting and pressure to sign. Use Care Compare on Medicare.gov to review CAHPS scores and ownership details. Ask specific questions about care practices and staff qualifications. If you see any red flags, move on to another hospice. If the hospice passes these checks, it is likely a good choice for your loved one.
You are looking for a hospice for your parent or loved one. You want to be sure the hospice is legitimate and provides good care. This section will help you find a hospice you can trust.
Who Qualifies for Medicare Hospice
Medicare Part A covers hospice when a hospice doctor and your parent's regular doctor (if they have one) certify that your parent has a terminal illness with a life expectancy of 6 months or less if the illness runs its normal course. Your parent also signs a statement choosing comfort care instead of treatment aimed at curing the terminal illness. Medicare still covers care for health problems unrelated to the terminal illness.
Hospice is given in benefit periods: two 90-day periods, then an unlimited number of 60-day periods, with a doctor recertifying eligibility each time. Your parent can leave hospice at any time and go back to regular Medicare coverage. Families usually pay little or nothing: there may be a copay of up to $5 per prescription for pain and symptom drugs, and 5% of the Medicare-approved amount for inpatient respite care.
Knowing these rules helps you spot fraud. Be cautious if a hospice tries to enroll someone who is not seriously ill, or describes hospice as simply "extra help at home" without explaining that it means stopping curative treatment for the terminal illness.
Red Flags to Watch For
When choosing a hospice, be alert to red flags that may indicate improper practices or fraud. Door-to-door recruiting, offers of 'free' services, and pressure to sign contracts quickly are common signs of potential trouble. These tactics can be used to rush families into making decisions without fully understanding the services or costs involved. To protect your loved one, take your time to research and ask questions before committing to any hospice. If something feels off or too good to be true, it likely is. Trust your instincts and seek out reputable hospices with solid reviews and transparent practices. AARP provides more details on how to spot and avoid hospice fraud.
Understanding CAHPS Hospice Survey Scores
CAHPS scores are part of the Hospice Quality Reporting Program (HQRP) by the Centers for Medicare & Medicaid Services (CMS). These scores come from the CAHPS Hospice Survey, which asks family caregivers of deceased hospice patients about their loved one's care. The survey covers topics like starting hospice care, symptom management, communication with the hospice team, and overall satisfaction. Scores are collected through mail, phone, or a mix of both, several months after the patient's death. Higher CAHPS scores generally indicate better quality of care, but it's important to look at multiple scores and other quality measures for a full picture. To interpret these scores, compare them with other hospices and consider what aspects of care are most important to you and your loved one. Visit Care Compare on Medicare.gov to see CAHPS scores and other quality information for hospices in your area.
Ownership and Accreditation Checks
Checking hospice ownership and accreditation is vital to ensure the hospice meets all legal and quality standards. Ownership details can reveal potential conflicts of interest or a history of improper practices, while accreditation confirms the hospice adheres to recognized quality benchmarks.
Visit the Care Compare on Medicare.gov to find detailed information about hospices, including ownership, quality measures and family survey scores.
Ask whether the hospice is accredited, and by whom. CMS-approved accrediting organizations for hospice include The Joint Commission, the Community Health Accreditation Program (CHAP) and the Accreditation Commission for Health Care (ACHC). You can confirm accreditation on the accreditor's website.
Review the hospice's ownership information. Be cautious of hospices with frequent changes in ownership or those owned by individuals with a history of legal issues.
Ask your state health department for the hospice's most recent inspection (survey) reports. These list any deficiencies inspectors found and whether they were corrected.
Questions to Ask When Vetting a Hospice
When choosing a hospice for your loved one, it's important to ask detailed questions to make sure the care fits their needs. Here are some key questions to consider:
What are the qualifications and certifications of the hospice staff?
How does the hospice manage pain and other symptoms?
What are the weekend and after-hours care options?
How does the hospice communicate with patients and families?
What are the patient outcomes and satisfaction rates?
Has the hospice had any deficiencies in recent state or Medicare inspections, and how were they fixed?
How does the hospice handle transitions in care?
What support is available for family caregivers?
Which services, medications and equipment are covered, and will we ever be billed for anything?
How quickly will a nurse come to the home during a crisis, including at night?
Common Questions
What should I do if I suspect hospice fraud?
Report it to the Medicare Fraud Hotline at 1-800-MEDICARE or the Office of Inspector General at 1-800-HHS-TIPS. Also, contact your state's Medicaid Fraud Control Unit.
How can I find a reputable hospice?
Use Care Compare on Medicare.gov to check a hospice's CAHPS scores and other quality measures. Look for accreditation from the Joint Commission or the Community Health Accreditation Program (CHAP).
What questions should I ask when vetting a hospice?
Ask about their pain management protocols, weekend care availability, and how they handle emergencies. Request to see their CAHPS scores and ask for references from other families.
Bottom line: Take proactive steps to verify a hospice's legitimacy and quality. Use available resources and ask detailed questions to ensure you choose a hospice that meets your loved one's needs.
Related reading: Understanding Hospice as Comfort-Focused Care (For Families) and Goals of Care Conversations: Language That Respects Everyone.
This article is general information, not medical advice or a diagnosis. Talk with your loved one's doctor or care team about their specific needs.
If you need help finding hospice care near you, you can search providers on Ubora Health.
