Hospice & palliative care

Choosing a Hospice in New Hampshire: Reading the Public Data

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New Hampshire's roughly two dozen hospices serve a population that is aging faster than almost any other state's, with its oldest and most isolated residents concentrated in its most rural counties. The same Care Compare and CAHPS Hospice tools that work nationwide apply here too, but reading them well means also understanding how the state licenses hospices and where its rural access gaps actually sit.

Last updated: July 2026

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What Actually Separates a Good Hospice From an Available One?

A hospice's quality is not something a family can read off how quickly its intake line answers or how polished its brochure looks. It shows up in three kinds of public record: what families who used the hospice later reported about their experience, how often patients were discharged alive and then hospitalized, and whether the hospice is for-profit or nonprofit. Comparing those records across the roughly two dozen hospices serving New Hampshire is the actual work of choosing one.

That comparison runs the same way whether a family lives near Manchester in the south or in the North Country near the Canadian border, though a rural search will typically return a shorter list with more distance between options. None of it replaces a direct conversation with a hospice's intake team about a specific patient's needs; it narrows the list worth having that conversation with.

Comparing Every Hospice Certified to Serve New Hampshire

Medicare's Care Compare tool lists every Medicare-certified hospice by ZIP code, along with the same quality measures CMS collects nationwide, including CAHPS Hospice results and claims-based utilization data 1. A search from a Concord or Nashua address will usually surface a longer list than one from a town near the Vermont or Canadian border, simply because more hospices are based in New Hampshire's more populated southern tier.

A family that moves between the North Country and the Seacoast partway through a patient's illness, to be closer to relatives or a specific hospital, can run the same search again from the new address without starting over. Confirming that a hospice's stated service area actually reaches the specific town in question, rather than assuming statewide coverage, is worth doing before enrolling.

New Hampshire Is Aging Faster Than Nearly Any Other State, and Its Rural Counties Feel It Most

New Hampshire has the second-oldest population in the country by median age, behind only Maine, and more than a quarter of its residents are 60 or older. That aging trend is not spread evenly: rural residents in counties like Coos, in the state's North Country, tend to be older on average, more likely to live alone, and more likely to report poor physical or mental health than residents of the state's more populated southern corridor near Manchester and Nashua.

Nationally, Alzheimer disease or another form of dementia is present in nearly half of hospice services users, a population that often needs longer, more predictable caregiver support rather than a short crisis-driven stay 2. In a rural New Hampshire county with fewer nearby clinicians, a family caring for a person with dementia may lean more heavily on a hospice's aide hours and its ability to train an isolated caregiver, which makes those specific services worth asking about directly rather than assuming every certified hospice offers the same depth of support.

New Hampshire Repealed Its Certificate-of-Need Law in 2016

New Hampshire became one of the earlier states in the country to repeal its certificate-of-need law, the state review some states still use to require proof of unmet community need before a new health facility can open. Since that 2016 repeal, a hospice has not needed to clear that additional hurdle to begin operating in the state, on top of its state license and Medicare certification.

That lower bar to enter the market says nothing about the quality of any specific hospice; it affects how many Medicare-certified programs a New Hampshire family might have to compare, not how good any one of them is. A hospice's own CAHPS score and live-discharge history still carry the weight of the comparison, regardless of how long it has operated or how it entered the market.

What the CAHPS Hospice Survey Actually Measures

The CAHPS Hospice Survey is a standardized questionnaire CMS mails to the primary caregiver of a patient who died under hospice care, usually a few months later, covering communication, symptom management, timeliness, caregiver training, and whether the family would recommend the hospice 3. It feeds into the Hospice Quality Reporting Program, which requires every Medicare-certified hospice to submit data or face a reduced payment rate 4.

Because the survey is retrospective and drawn from a limited number of respondents, a single strong or weak domain should not stand in for the whole picture. Reading several CAHPS domains together, rather than only the overall recommend-us figure, shows more about where a hospice was strong and where families reported gaps.

Why Live Discharge and Ownership Both Show Up in the Research

Being discharged alive from hospice is not inherently a problem; some patients stabilize and no longer meet the terminal prognosis. But researchers have found that patients discharged alive are more likely to be hospitalized, readmitted, or die in a hospital shortly afterward, and that pattern is more common at for-profit hospices and after unusually short stays 5.

A separate national analysis of CAHPS Hospice data found that family caregivers reported worse experiences, across every domain measured, at for-profit hospices compared with nonprofit ones, and were less likely to recommend them 6. Ownership alone does not settle the question for any one hospice in New Hampshire — plenty of individual programs of either kind perform well — but it is worth checking alongside CAHPS scores, not instead of them.

Checking a Hospice's License Through New Hampshire's Health Facilities Administration

Every hospice operating in New Hampshire is licensed and inspected by the Health Facilities Administration within the New Hampshire Department of Health and Human Services, under a specific set of state rules written for home hospice care providers. That state licensing and complaint record is separate from the federal Care Compare and CAHPS data, and it is public information a family can request directly from the state.

A hospice can hold current Medicare certification while also carrying an open state complaint or a recent inspection finding, since the two systems are maintained by different bodies. Checking both the state licensing record and the federal quality data covers more ground than either one alone, whether the hospice in question is based near Concord or serves a town much farther north.

Common questions

New Hampshire's list is shorter than a large state's, with roughly two dozen Medicare-certified hospices statewide, but it is not a single-provider market. The state also repealed its certificate-of-need law in 2016, which removed one hurdle to opening a new hospice. Checking each one's CAHPS score, live-discharge pattern, and ownership still matters, regardless of how short the list is.

New Hampshire has the second-oldest population in the country by median age, and its rural North Country counties skew even older than the southern part of the state. Nationally, nearly half of hospice patients have Alzheimer disease or another dementia, a population that often needs sustained caregiver training and aide support rather than a short crisis stay, so asking about the depth of those specific services is worth doing.

Not necessarily, even if the hospice's coverage map lists the whole state. More hospices are based in New Hampshire's southern tier, and a program headquartered there may have a thinner staffing footprint reaching a town near the Canadian border. Asking a hospice directly how it staffs a specific rural town is more informative than the coverage map alone.

Complaints go to the Health Facilities Administration within the New Hampshire Department of Health and Human Services, the state body that licenses and inspects hospices, separate from CMS's Care Compare and CAHPS data. A family can raise a concern with both: the state agency for a licensing or care-standard issue, and CMS if it touches Medicare-reported quality measures.

No single ownership label guarantees an outcome for any one family. National research has found for-profit hospices score lower, on average, across CAHPS domains and show more burdensome live discharges, but averages describe an industry, not one program. A specific hospice's own public record, checked directly, matters more than its tax status.

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When to Escalate Beyond Comparison Shopping

  • —a hospice's on-call clinical line goes unanswered, or reaches only voicemail, during a symptom crisis
  • —pain, breathlessness, or agitation isn't addressed within the response time the hospice promised in writing
  • —no clinician contact for several days after a family reports a real change in a patient's condition
  • —a hospice cannot describe how it actually staffs a specific North Country town, especially in winter

If a hospice patient is in acute distress and the hospice's 24-hour clinical line cannot 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 New Hampshire; 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 New Hampshire families can search and compare Medicare-certified hospices by ZIP code on publicly reported quality and CAHPS measures.
  2. 2.National Center for Health Statistics (CDC) (2024). Overview of Post-acute and Long-term Care Providers and Services Users in the United States, 2020 (National Health Statistics Reports No. 208). National Center for Health Statistics (CDC). link ✓Supports that Alzheimer disease or another dementia is present in nearly half of hospice services users nationally.
  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.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, as the data source behind Care Compare.
  5. 5.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.
  6. 6.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 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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