Provider Comparison Framework

Framework Overview

This framework provides a systematic way to evaluate and compare hospice providers beyond just star ratings. Use it to assess each provider you're considering across five key categories: Services, Team & Experience, Quality, Financial & Practical, and Red Flags.

How to Score

For each provider, rate them 1-5 (1=poor, 5=excellent) on each criterion. Calculate the average score for each category, then compare providers side-by-side. This helps you make decisions based on what matters most to your family.

Remember Your Needs

The "best" hospice is the one that best meets YOUR family's specific needs, values, and circumstances. A 5-star hospice that doesn't serve your area or accept your insurance isn't the right choice.

Care Settings Available

Does the hospice offer home care, inpatient hospice facilities, nursing home care, and assisted living support? Flexibility matters if your loved one's needs change.

Core Hospice Services

All hospices must provide: skilled nursing, physician services, home health aide, social work, chaplain, bereavement support, medications, and medical equipment. Verify no extra charges.

Specialty Services

Does the hospice have expertise in your loved one's condition (cancer, dementia, heart disease, pediatrics)? Ask about specialized programs and staff training.

24/7 Nurse Availability

Can you reach a nurse 24 hours a day, 7 days a week? How quickly do they respond to after-hours calls? Can a nurse come to your home in an emergency?

Respite Care

Does the hospice offer respite care to give family caregivers a break? How many days per year? What's the notice period required?

Complementary Therapies

Does the hospice offer music therapy, pet therapy, art therapy, or massage? While not required, these can significantly improve quality of life.

Bereavement Support Duration

How long does bereavement support last after death (minimum is 12 months)? What does it include: support groups, counseling, memorial events?

Nurse-to-Patient Ratio

What is the current nurse caseload? Lower is better (1:10 to 1:15 is typical, but 1:8 or less is ideal). High caseloads can mean less frequent visits and less personalized attention.

Staff Credentials and Training

What percentage of nurses are RNs vs. LPNs? Are nurses certified in hospice and palliative care (CHPN)? What ongoing training do staff receive?

Physician Involvement

Will a hospice physician see your loved one, or do they rely solely on your primary doctor? How quickly can a physician be reached in a crisis?

Interdisciplinary Team Meetings

How often does the team (nurse, doctor, social worker, chaplain) meet to discuss your loved one's care? Weekly team meetings indicate coordinated, comprehensive care.

Continuity of Care

Will you have the same nurse each visit, or does it rotate? Consistency helps build trust. Ask about their staff retention rate—high turnover can disrupt care.

Language and Cultural Competency

Do they have staff who speak your language? Do they demonstrate understanding of your cultural or religious practices around death and dying?

Years in Operation

How long has this hospice been serving your community? Established hospices (5+ years) often have more resources and better-trained staff.

Medicare Quality Star Rating

Check Medicare Care Compare for their star rating (1-5 stars). 4-5 stars indicates high quality. No rating doesn't mean poor quality—it means they haven't reported yet.

CAHPS Scores (Patient Satisfaction)

If available, review their CAHPS survey scores. These measure family satisfaction with communication, pain management, respect for wishes, and emotional support. Scores above 85% are good.

Clinical Quality Measures

Check their scores for pain screening, shortness of breath management, and treatment preference documentation. Good scores: 90%+ for pain/breathing, 85%+ for preferences.

Accreditation

Is the hospice accredited by The Joint Commission, ACHC, or CHAP? Accreditation is voluntary and indicates meeting higher quality standards.

Online Reviews and Reputation

Read Google reviews, Facebook reviews, and testimonials. Look for patterns in feedback. Consistent complaints about the same issue are red flags.

Quality Improvement Initiatives

Ask what they're doing to improve care. Do they track quality metrics internally? Can they describe specific improvements made in the past year?

State Survey Results

Check your state health department website for inspection reports and complaints. Serious deficiencies or repeated violations should give you pause.

Insurance Acceptance

Do they accept your insurance: Medicare, Medicaid, VA benefits, private insurance? What out-of-pocket costs should you expect? Get this in writing.

Service Area Coverage

Do they serve your specific location? What is their geographic coverage area? If you live in a rural area, confirm they can reach you reliably.

Visit Frequency

How often will a nurse visit? Daily? Weekly? As needed? More frequent visits are generally better for symptom management, especially in final days.

Response Time to Calls

How quickly do they typically return phone calls during business hours? After hours? Same-day responses should be standard.

Medication and Equipment Delivery

How quickly can they deliver medications and medical equipment? Do they have an on-call pharmacy? Same-day delivery for urgent needs is ideal.

Size and Capacity

How many patients does this hospice currently serve? Large hospices may have more resources but less personalized care. Small hospices may be more personal but have limited backup staff.

Ownership Structure

Is this a nonprofit, for-profit, or government-run hospice? All can provide excellent care, but understand their mission and incentives.

Unwilling to answer questions

Being evasive about quality scores, costs, or services is a red flag.

Pressure to enroll immediately

Avoid providers pushing enrollment without time to review documents or compare options.

Dismissive of goals

Watch for providers pushing their preferences over your family's wishes and values.

Vague about coverage and costs

They should clearly explain what's included and what you'll be responsible for paying.

Not available 24/7

24/7 nurse support is a basic requirement of hospice care, not optional.

No bereavement support

Limited bereavement services (less than 12 months) indicate inadequate family support.

High staff turnover

Staff turnover mentioned in reviews or during conversations suggests instability.

Unwilling to provide references

Good providers are comfortable providing references from current or former patients/families.

Consistent negative reviews

Look for patterns in feedback about poor communication, unreliable staff, or billing problems.

Serious deficiencies

Check state inspection reports for serious deficiencies or history of enforcement actions.

Sales-focused approach

Be wary of providers focused on sales rather than understanding your loved one's needs.

You don't feel respected

Trust your instincts about whether you feel heard and respected during your interactions.