Hospice & palliative care

Choosing a Hospice in Hawaii: Reading the Public Data

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Hawaii's hospice landscape is shaped by two facts that don't apply almost anywhere else in the country: the state runs hospice openings through a formal Certificate of Need review, and the general inpatient level of hospice care is available mainly on Oahu and Maui. This guide covers what that means for a Hawaii family's search, alongside the same federal quality data every state shares.

Last updated: July 2026

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Hawaii requires a Certificate of Need for a new hospice

Hawaii's State Health Planning and Development Agency, part of the state Department of Health, reviews and approves Certificate of Need applications before a new hospice can open in the state — a more restrictive posture than many mainland states, which have dropped Certificate of Need requirements for hospice or never had them. Applications are weighed against the state's Health Services and Facilities Plan, including need and accessibility in the specific area proposed.

For a family, this means the number of hospices serving a given island has already passed through a state review process, unlike a state where any qualifying applicant can open. That is not a guarantee of quality — CON review is about need and capacity, not caregiver experience — but it does mean supply is intentionally limited, which is worth knowing before assuming more options exist than actually do.

Inpatient hospice care is concentrated on Oahu and Maui

Medicare's hospice benefit includes four levels of care: routine home care, continuous home care during a brief crisis, general inpatient care when symptoms can't be managed at home, and inpatient respite care for caregiver relief 5. In Hawaii, dedicated inpatient hospice capacity for the general-inpatient level is concentrated on Oahu and Maui, which means a patient on one of the other islands who needs that level of care during a symptom crisis may require a transfer between islands to reach it.

This is a genuinely Hawaii-specific question worth asking directly: if general inpatient care becomes necessary, where does this hospice actually send a patient, and how is that transfer arranged. A hospice that has never had to answer this for a specific island is not automatically unprepared, but the answer should be concrete, not vague reassurance.

What Care Compare and the CAHPS Hospice Survey show

Every Medicare-certified hospice serving Hawaii is listed on Care Compare, which reports CAHPS Hospice Survey results — a standardized survey of family caregivers of patients who have died, covering communication, symptom management, timeliness, and willingness to recommend — alongside claims-based quality measures 12. Judging hospice quality this way works identically in Hawaii as anywhere else in the country; the instrument itself doesn't change by geography.

A hospice's overall recommendation score can still mask a weaker domain, such as how quickly staff responded to urgent calls — the domain many families care about most, especially where distance or interisland logistics could slow a response. Care Compare breaks CAHPS Hospice Survey results out by domain, and reviewing those individually matters more in a state with real geographic access questions.

A hospice's live discharge rate and who owns it

A hospice live discharge rate — the share of patients who leave hospice care alive rather than through death — is worth checking regardless of state, because a pattern of live discharges concentrated near the Medicare payment cap can signal a hospice enrolling patients who were never really appropriate for the benefit 3. A single live discharge is often clinically appropriate; a consistent pattern is the signal worth noticing.

Ownership is part of the same picture. National research using CAHPS Hospice Survey data has found that family caregivers report worse experiences, across every measured domain, at for-profit hospices compared with nonprofit ones, and are less likely to recommend them 4. That is not a verdict on any specific Hawaii agency, but a reason to check its actual scores directly.

Local reach on a specific island, not just island coverage

A hospice licensed to serve an island like Hawaii Island or Kauai may still cover an enormous, sparsely populated land area within that single license — being "covered" on paper doesn't mean a nurse can reach a remote address as quickly as one near a town center. This matters more in Hawaii than in most states, where county lines usually track more evenly with population density.

Asking a hospice directly how it staffs a specific address, rather than accepting that an island is generally served, is a reasonable question anywhere in Hawaii outside the main population centers. A hospice with a real local presence should be able to describe typical response times for a specific area without hedging.

Checking a hospice's Hawaii certification and complaint history

Hawaii's Department of Health, through its Office of Health Care Assurance, certifies hospices for Medicare and Medicaid participation and handles the state's inspection and complaint process — separate from the State Health Planning and Development Agency's Certificate of Need review that governs whether a hospice could open in the first place. These are two different checks: one about whether the hospice was allowed to open, one about how it has performed since.

A family can reasonably ask a hospice whether any complaints have been filed and how they were resolved, or contact the Office of Health Care Assurance directly. Confirming this before enrollment, rather than after a concern arises, is a fair use of that public process.

The same method works in every state

None of this changes by geography — only the specific regulatory and physical layer on top does. Judging hospice quality through a CAHPS Hospice Survey and a hospice live discharge rate works the same way whether the question is hospice quality in Louisiana or hospice quality in Hawaii, and a family choosing a hospice in Louisiana reads the identical Care Compare filters as one choosing a hospice in Maine.

The same holds further down the list: hospice quality in Maine and hospice quality in Maryland rest on the same federal data as choosing a hospice in Maryland, choosing a hospice in Massachusetts, hospice quality in Massachusetts, hospice quality in Michigan, and choosing a hospice in Michigan. What changes state to state is whether a Certificate of Need gates entry the way it does here, and how far a patient might be from the specific level of care they need.

Common questions

Hawaii's State Health Planning and Development Agency reviews Certificate of Need applications for new hospices, weighing need and accessibility against the state's health services plan. This makes Hawaii more restrictive than many mainland states that have dropped or never had hospice Certificate of Need requirements, which means supply is intentionally limited rather than open to any qualifying applicant.

General inpatient hospice care, one of Medicare's four hospice levels of care, is concentrated on Oahu and Maui. A patient elsewhere who needs that level of care during a symptom crisis may require an interisland transfer, so it's worth asking a hospice directly how it handles this for the specific island where care will happen.

Not necessarily. A hospice licensed to serve an island can still cover a large, sparsely populated area within that license, so travel time to a specific remote address can vary widely even within one island. Asking about typical response times for a specific location is more useful than confirming general island coverage.

Hawaii's Department of Health, through its Office of Health Care Assurance, certifies hospices for Medicare and Medicaid and handles inspections and complaints, separate from the Certificate of Need review that governs whether a hospice could open. A family can ask a hospice directly about any complaints or contact the office to confirm current certification.

Not automatically. Because Hawaii limits new hospices through Certificate of Need review, a wider footprint reflects approved expansion rather than documented caregiver experience. Reading CAHPS Hospice Survey domain scores and a hospice's live discharge rate for a specific island gives a clearer answer than counting locations.

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Before choosing a hospice in Hawaii

  • —the hospice cannot describe how it would arrange general inpatient care, including any interisland transfer, if symptoms become unmanageable at home
  • —the hospice cannot give a concrete answer about typical response times for your specific address
  • —the hospice cannot describe how its on-call nurse line is staffed overnight and on weekends
  • —the hospice pressures a same-day enrollment decision or discourages contacting the Office of Health Care Assurance first

If a hospice patient in Hawaii is in acute physical distress and the hospice's on-call nurse line does not respond, calling 911 for immediate help is appropriate — enrolling in hospice does not prevent emergency responders from being called.

This article is educational and does not replace guidance from a hospice's admissions or clinical staff, from Hawaii's Department of Health, or from 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 ✓Confirms hospices are publicly searchable and comparable on Care Compare by ZIP code, and that CAHPS Hospice Survey and quality measures are reported there.
  2. 2.Centers for Medicare & Medicaid Services (2024). CAHPS Hospice Survey. Centers for Medicare & Medicaid Services (CMS). link ✓Describes what the CAHPS Hospice Survey measures (communication, symptom management, timeliness, willingness to recommend) and that it samples caregivers of deceased patients.
  3. 3.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 patterns of live discharge, especially for-profit and short-stay, are associated with burdensome post-discharge transitions.
  4. 4.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 care experiences across CAHPS domains at for-profit versus not-for-profit hospices, and are less likely to recommend them.
  5. 5.Centers for Medicare & Medicaid Services (2024). Medicare-Certified 4 Levels of Hospice Care. Medicare.gov / Care Compare (CMS). link ✓Defines the four Medicare hospice levels of care, including general inpatient care for symptom management not manageable at home.

5 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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