Hospice & palliative care

Choosing a Hospice in the Charlotte, NC Area

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North Carolina requires a certificate of need before a new hospice can open, which tends to keep the local list of options shorter and more stable than in states with open entry. Because the Charlotte-Concord-Gastonia metro area crosses into South Carolina, some hospices serving Charlotte families are licensed, inspected, and disciplined under a different state's health department entirely.

Last updated: July 2026

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Read Care Compare Before Anything Else

Medicare's Care Compare website is a free public search tool covering every Medicare-certified hospice, searchable by ZIP code, that reports the same quality measures nationwide: family-experience survey results and claims-based utilization data drawn from actual Medicare billing records 1. For a Charlotte-area family, it is the fastest way to see a candidate hospice's public track record before a single phone call is made.

That data comes from the Hospice Quality Reporting Program (HQRP), which requires every Medicare-certified hospice to submit standardized data or accept a reduced Medicare payment rate 2. HQRP includes the CAHPS Hospice family-experience survey and the newer HOPE assessment, a clinical data tool CMS phased in to track patient status during a hospice stay. Reading Care Compare doesn't answer which hospice is right for a particular patient; it narrows the field to what's actually documented, rather than what a brochure or a hospital discharge planner happens to mention. It also lets a family weigh a hospice on the North Carolina side of the metro against one across the state line in South Carolina on the exact same national measures, since Care Compare draws from Medicare's own data regardless of which state licensed the hospice.

North Carolina Requires a Certificate of Need Before a New Hospice Can Open

North Carolina requires a hospice to obtain a certificate of need (CON) before it can begin operating, a process tied to the state's official medical facilities plan. If that plan doesn't show a documented need for an additional hospice in a given service area, no certificate is issued, no matter how interested an operator might be. Once a CON is granted, the hospice still needs a separate state license from North Carolina's Division of Health Service Regulation before it can see patients.

That two-step process tends to produce a shorter, more stable list of hospices serving a given part of the Charlotte metro than in a state with open entry. A shorter list isn't automatically a safer one — it means the small number of licensed options in a service area deserve a closer look apiece, since there may not be a large field of alternatives to switch to if a first choice isn't working out.

What the CAHPS Hospice Survey Asks Families

The CAHPS Hospice Survey is mailed to the primary caregiver of a patient who died under hospice care, typically a few months afterward, and asks about communication, symptom management, timeliness of visits, caregiver training, and whether the family would recommend the hospice 3. It captures a caregiver's retrospective account, not a real-time satisfaction check.

Because each hospice's score is built from a limited number of respondents over a defined period, a single strong or weak domain shouldn't be read in isolation. A hospice that scores well on communication but poorly on getting help quickly, for instance, is telling a specific story worth asking about directly, rather than a single number that resolves the whole picture. Care Compare displays these CAHPS results alongside claims-based measures, so a hospice's survey scores can be weighed against how often its patients were hospitalized or discharged alive before the end of a stay.

Some Charlotte-Area Hospices Answer to South Carolina, Not North Carolina

The Charlotte metro area, as the federal government defines it, crosses a state line: the Charlotte-Concord-Gastonia metropolitan statistical area includes North Carolina counties like Mecklenburg, Cabarrus, and Union alongside York, Lancaster, and Chester counties in South Carolina. A hospice serving a family in one of those South Carolina counties is licensed, inspected, and disciplined by South Carolina's health department, not North Carolina's, even though the household considers itself part of greater Charlotte.

That distinction matters when checking a hospice's licensing history or filing a complaint. The right state agency to contact, and the specific inspection portal to search, depends on which side of the state line the hospice itself is licensed in, not which side of the line the patient lives on. Confirming a hospice's home state before digging into its record saves a family from searching the wrong state's public records altogether.

Ownership and Live-Discharge Patterns Worth Checking

Being discharged alive from hospice care isn't automatically a warning sign; some patients stabilize and no longer meet the terminal prognosis hospice requires. Researchers have still found a pattern worth understanding: patients discharged alive are more likely to be hospitalized, readmitted, or die in a hospital shortly afterward, and this kind of burdensome transition shows up more often at for-profit hospices and after unusually short stays 4.

A national study of CAHPS Hospice results found that family caregivers reported worse experiences, across every measured domain, at for-profit hospices than at nonprofit ones, and were less likely to say they'd recommend the hospice 5. Ownership doesn't decide the outcome for any single family — individual programs of either kind can perform well or poorly — but it is one more data point worth weighing alongside a hospice's own CAHPS scores and live-discharge history. A hospice willing to walk a family through its own recent CAHPS results and explain a live-discharge figure in plain language is demonstrating exactly the kind of transparency these public measures are meant to reward.

More North Carolinians Now Qualify for Medicaid-Covered Hospice

North Carolina expanded Medicaid eligibility to more low-income adults starting December 1, 2023, extending coverage to hundreds of thousands of residents who previously had no consistent path to it. Medicaid's hospice benefit generally follows the same structure as Medicare's: the same four levels of care CMS defines nationally apply to Medicaid-covered hospice patients as well as Medicare-covered ones — routine home care, continuous home care during a brief crisis, general inpatient care, and inpatient respite care for a caregiver's break 6.

For a Charlotte-area family newly eligible under expansion, that means the vetting method described here doesn't change based on which program is paying: the same Care Compare listings, the same CAHPS scores, and the same four levels of care apply whether hospice is billed to Medicare or to North Carolina's Medicaid program.

Common questions

It tends to mean a shorter list than in a state with open entry, since a new hospice can't open unless the state's medical facilities plan shows a documented need in that service area. A shorter list doesn't mean lower quality; it means the available options are worth comparing carefully on Care Compare and CAHPS data rather than assuming any one of them is interchangeable with the others.

The Charlotte metro area straddles the state line, and a hospice's licensing state depends on where the hospice itself is based, not where a patient lives. Asking directly which state issued the hospice's license, or checking the hospice's own materials, is the most reliable way to know which state's inspection records and complaint process actually apply.

Expansion changed who qualifies for Medicaid, not what the hospice benefit itself covers. More North Carolina adults became eligible for Medicaid starting December 1, 2023, and those who need hospice care receive the same four levels of care Medicare-covered patients receive. What changed is access to coverage, not the structure of the hospice benefit.

Routine home care is the standard level most hospice patients receive at home, in a nursing facility, or wherever they live day to day. General inpatient care is short-term and facility-based, used when symptoms need more intensive management than a home setting allows. Continuous home care covers a brief home crisis, and inpatient respite care gives a family caregiver a short planned break.

No. Ownership status describes a pattern across many hospices, not a certainty about one program. National data shows for-profit hospices score lower on average across CAHPS domains and show more burdensome live discharges, but individual for-profit and nonprofit hospices fall outside that average in either direction. A hospice's own public record is the more reliable check.

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Knowing When to Escalate Beyond the Hospice Team

  • —the hospice's on-call clinical line rings through to voicemail during an active symptom crisis
  • —uncontrolled pain, breathlessness, or agitation that isn't addressed within the response time promised in writing
  • —several days pass with no clinician contact after a family reports a real change in condition

If a hospice patient is in acute distress and the hospice's 24-hour clinical line can't be reached, call 911 and tell the dispatcher the patient is enrolled in hospice care.

This article explains how to read public hospice-quality data for the Charlotte area; it does not replace guidance from a hospice's own clinical team or a treating physician.

References

  1. 1.Centers for Medicare & Medicaid Services (2024). Find Healthcare Providers: Compare Care Near You (Hospice). Medicare.gov / Care Compare (CMS). link ✓Supports that Charlotte-area families can search and compare Medicare-certified hospices by ZIP code on publicly reported quality and CAHPS measures.
  2. 2.Centers for Medicare & Medicaid Services (2024). Hospice Quality Reporting Program. Centers for Medicare & Medicaid Services (CMS). link ✓Supports the existence and structure of the Hospice Quality Reporting Program, including CAHPS Hospice and the HOPE assessment, as the data source behind Care Compare.
  3. 3.Centers for Medicare & Medicaid Services (2024). CAHPS Hospice Survey. Centers for Medicare & Medicaid Services (CMS). link ✓Supports what the CAHPS Hospice Survey is, who it samples, and which domains it measures.
  4. 4.Peer-reviewed cohort study (see article) (2024). Hospice Readmission, Hospitalization, and Hospital Death Among Patients Discharged Alive from Hospice. JAMA Network Open (PMC11099680). PMID 38753329 ✓Supports that patients discharged alive from hospice face higher rates of hospitalization, readmission, or hospital death, and that this is more common at for-profit hospices and after short stays.
  5. 5.Anhang Price R, Parast L, Elliott MN, et al. (2023). Association of Hospice Profit Status With Family Caregivers' Reported Care Experiences. JAMA Internal Medicine. doi:10.1001/jamainternmed.2022.7076 ✓Supports that family caregivers report worse experiences across CAHPS domains at for-profit hospices compared with nonprofit hospices.
  6. 6.Centers for Medicare & Medicaid Services (2024). Medicare-Certified 4 Levels of Hospice Care. Medicare.gov / Care Compare (CMS). link ✓Supports the definitions of the four Medicare hospice levels of care.

6 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy

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