Choosing a Hospice in Tennessee: Reading the Public Data

Start with Care Compare, filtered to your Tennessee county

Medicare's Care Compare is the federal government's public tool for comparing every Medicare-certified hospice by county, including CAHPS Hospice family-experience scores and each agency's live-discharge rate 1Ref 1Centers for Medicare & Medicaid Services (2024).Find Healthcare Providers: Compare Care Near You (Hospice).That Care Compare is the official public tool for comparing Medicare-certified hospices by location, including CAHPS Hospice family-experience scores and live-discharge rates.. Search by Tennessee county or ZIP code, and the tool returns every certified agency serving that area along with its most recent scores — the same starting point recommended for judging hospice quality anywhere in the country.

How long that list runs varies a great deal across Tennessee. A search from Nashville or Memphis will typically return more names than a search from a rural county in the eastern mountains, for reasons that are specific to how Tennessee regulates new hospices — covered next.

Tennessee's Certificate of Need law and why rural counties have fewer choices

Tennessee is one of the states that still requires a Certificate of Need before a new hospice can be licensed to operate in a given area — a state health-planning review that weighs whether existing hospice capacity in a county is already adequate before letting a new agency open. In practice, that slows the entry of new agencies compared with a state that places no such limit on new licenses.

A shorter list is not itself a red flag. It does mean that in a rural Tennessee county served by only one or two agencies, there are fewer alternatives if the first one you call is a poor fit, which makes reading that agency's CAHPS Hospice scores and live-discharge rate carefully, rather than skimming past them, more important than it would be in a market with a dozen options to compare.

When a county has only one certified hospice, or none, Care Compare's radius search is worth widening past county lines; a Tennessee family in a smaller county often ends up working with an agency based in a neighboring county or the nearest metro, and confirming that agency actually staffs regular visits to a specific rural address, rather than listing the county as covered on paper, is worth doing before enrolling.

Nashville, Memphis, Knoxville, and Chattanooga versus rural Tennessee

Tennessee's hospice capacity concentrates around its four largest metros — Nashville, Memphis, Knoxville, and Chattanooga — while rural counties, especially in the Appalachian mountains of the state's east, generally have fewer agencies and longer drive times for a nurse or aide to reach a patient's home.

That gap matters most for the more intensive levels of hospice care: continuous home care during a brief crisis, general inpatient care when symptoms can't be managed at home, and inpatient respite care for a caregiver's break, alongside routine home care 2Ref 2Centers for Medicare & Medicaid Services (2024).Medicare-Certified 4 Levels of Hospice Care.The definitions of the four Medicare hospice levels of care: routine home care, continuous home care, general inpatient care, and inpatient respite care.. In a rural county with only one or two certified agencies, it's worth asking directly where that agency's inpatient beds are located and how far a continuous-care team would actually need to travel during a middle-of-the-night crisis — in parts of rural East Tennessee, that can be a genuine mountain drive, not a formality.

The same distance question applies to inpatient respite care, the level meant to give a caregiver a break: an agency's contracted respite beds might sit in Knoxville or Chattanooga rather than the patient's own county, which can turn a short break into a stressful transfer if the family hasn't asked about it in advance.

What ownership status tells you

Whether a Tennessee hospice is for-profit or nonprofit is public information on Care Compare, and it correlates with real differences nationally. Family caregivers surveyed through CAHPS Hospice rated for-profit hospices lower across every domain than nonprofit hospices, and less likely to recommend them 3Ref 3Anhang Price R, Parast L, Elliott MN, et al. (2023).Association of Hospice Profit Status With Family Caregivers' Reported Care Experiences.That family caregivers report worse care experiences across all CAHPS Hospice domains at for-profit than not-for-profit hospices, and are less likely to recommend them.. A separate analysis found problematic live discharges — a patient sent off hospice while still declining — are more common at for-profit agencies 4Ref 4Teno JM, Plotzke M, Christian T, Gozalo P (2015).Characteristics of Hospice Programs With Problematic Live Discharges.That problematic (burdensome) live-discharge patterns are far more common at for-profit than not-for-profit hospices..

Ownership isn't destiny for any single hospice; plenty of for-profit agencies score well. But with Tennessee's Certificate of Need law keeping some county lists short, checking each candidate's own CAHPS scores and live-discharge rate before calling is a faster, more reliable filter than guessing from tax status.

TennCare and hospice coverage

Medicaid covers hospice care for enrollees who qualify in every state, including through Tennessee's program, TennCare 5Ref 5Centers for Medicare & Medicaid Services (2024).Hospice Benefit Toolkit.That Medicaid covers hospice care for people who qualify, as part of the general framing of the Medicare/Medicaid hospice benefit structure.. Tennessee has not expanded Medicaid eligibility under the Affordable Care Act, so TennCare covers a narrower group of low-income adults than Medicaid programs in expansion states — largely children, pregnant women, parents who meet strict income limits, and people with disabilities, rather than any low-income adult under 65.

For a Tennessee family without Medicare, without private insurance, and without a TennCare category that fits, hospice for the uninsured typically runs through a hospice's own charity-care policy, and for a TennCare enrollee who is also a nursing-facility resident, Medicaid generally pays a room-and-board rate to the hospice on the resident's behalf, though the mechanics vary by state and are worth confirming directly 6Ref 6Centers for Medicare & Medicaid Services (2024).Hospice Payments (Medicaid).That for dually eligible nursing-facility residents, Medicaid generally pays a room-and-board rate to the hospice on the resident's behalf, and that the mechanics vary by state..

That gap is worth taking seriously in a state that hasn't expanded Medicaid, since it leaves more low-income Tennessee adults without an obvious coverage path than in a state that has. Getting a hospice's charity-care terms in writing during an intake call, rather than a general assurance that a family will be taken care of, is a reasonable thing to ask for.

Checking a license or filing a complaint with the state

The Tennessee Department of Health licenses and inspects hospices operating in the state and is the place to check a license or file a complaint about a specific agency's care — separate from Medicare's own hospice complaint process, and a useful second check given how few alternatives some rural counties have.

Asking a hospice directly whether it's had a recent state finding, and watching whether it answers plainly or changes the subject, is fair to do during an intake call, especially where a Certificate of Need has limited the field to one or two names. The same method for judging hospice quality carries over anywhere; families weighing choosing a hospice in Alabama or choosing a hospice in Arizona can run the identical checks against their own state's public data.