Choosing a Hospice in Washington: Reading the Public Data

What actually tells you a hospice is good?

Four things separate a strong hospice from a weak one, and all four are public record: the CAHPS Hospice Survey score for family experience, the share of patients discharged alive before death, whether the agency is for-profit or nonprofit, and the state's own licensing and complaint history. None of them requires a phone call to find.

Every Medicare-certified hospice in the country, including every one licensed in Washington, reports into the same national systems. CMS's Care Compare tool lets a family filter results by county and see which hospices have collected enough CAHPS Hospice Survey responses to publish a score 1Ref 1Centers for Medicare & Medicaid Services (2024).Find Healthcare Providers: Compare Care Near You (Hospice).Establishes Care Compare as the public tool for comparing Medicare-certified hospices in Washington by county on quality measures and CAHPS scores.. The survey itself samples the primary caregiver of a patient who has already died, usually a few months afterward, and asks about communication, help with symptoms, timeliness of care, and whether the family would recommend the hospice to others 2Ref 2Centers for Medicare & Medicaid Services (2024).CAHPS Hospice Survey.Describes what the CAHPS Hospice Survey measures and how it is collected, used to explain how to read a hospice's family-experience score.. That last question, willingness to recommend, is often the clearest single number for judging hospice quality between two agencies serving the same Washington county.

None of this replaces judgment. A hospice with a strong CAHPS score can still be the wrong fit for a specific family's needs, and a newer agency may not have enough responses yet to publish a score at all. But it is the honest starting point, and it costs nothing to check before a single phone call is made.

Washington's own licensing record, and why the state's approval process matters

Washington's Department of Health licenses every hospice operating in the state, runs its own inspection process, and keeps a complaint history that is separate from anything Medicare publishes. Checking both the federal quality data and the state's licensing record catches different problems, because different agencies collect them for different reasons.

Washington is also one of a shrinking number of states that requires a certificate of need before a new hospice agency can open. In practice, that means the number of agencies competing for patients in a given Washington county is capped by state approval, not just by how many organizations wanted to enter the market. A short list of hospices serving a rural Washington county is not necessarily a sign of thin data; it may simply mean the state has approved few agencies to operate there.

Medicare certification and Washington state licensure are two separate approvals, and a family should confirm both are current rather than assuming one implies the other. The state's facility search tools are the place to look up licensing status and any substantiated complaints filed against a specific agency, tracked separately from the CAHPS process.

Reading the live discharge rate next to the CAHPS score

A hospice's live discharge rate, the share of patients who leave hospice care alive rather than remain enrolled until death, is worth reading alongside its CAHPS score, because a high rate can mean a hospice is enrolling patients who were never quite appropriate for hospice, or discharging patients once their care becomes more resource-intensive.

Research following Medicare beneficiaries discharged alive from hospice found they face a meaningfully higher chance of hospitalization, readmission, or dying in a hospital rather than at home, and that this pattern shows up more often when the hospice was for-profit or the stay was short 3Ref 3Peer-reviewed cohort study (see article) (2024).Hospice Readmission, Hospitalization, and Hospital Death Among Patients Discharged Alive from Hospice.Supports the claim that patients discharged alive from hospice face a higher risk of burdensome transitions, especially at for-profit agencies or after short stays.. That does not mean every live discharge is a problem; some patients genuinely improve and graduate from hospice care, or choose to pursue a treatment that isn't compatible with the hospice benefit. But a Washington hospice with a live discharge rate that stands out from others serving the same county is worth a direct question: why, and how often does it happen to patients with a similar diagnosis.

Does ownership status matter?

Ownership status is one of the more consistent signals in the national research, and Washington has both for-profit and nonprofit hospices operating side by side, so it is worth checking for any specific agency under consideration. Family caregivers whose relative was cared for by a for-profit hospice report worse experiences across every domain the CAHPS Hospice Survey measures than families served by a nonprofit hospice, and are less likely to say they would recommend it 4Ref 4Anhang Price R, Parast L, Elliott MN, et al. (2023).Association of Hospice Profit Status With Family Caregivers' Reported Care Experiences.Supports the finding that families report worse experiences across CAHPS domains at for-profit hospices than nonprofit ones.. Separately, problematic live discharge patterns, the kind that leave a family scrambling for care mid-crisis, are documented more often at for-profit hospices than not-for-profit ones 5Ref 5Teno JM, Plotzke M, Christian T, Gozalo P (2015).Characteristics of Hospice Programs With Problematic Live Discharges.Supports that problematic live discharge patterns are documented more often at for-profit hospices, used as an ownership-related vetting signal..

This is not a rule that a nonprofit hospice will always be the better choice for a given family; individual agencies vary widely within both categories, and a for-profit hospice with strong local leadership can outperform a struggling nonprofit. But ownership status is public information on Care Compare's provider listing, and given what the research shows, it is a reasonable factor to weigh alongside the CAHPS score rather than ignore.

What the Cascades do to visit frequency

Washington's hospice landscape looks different depending on which side of the Cascade Mountains a family lives on, and that difference is worth raising directly with any agency before enrolling. A hospice based in the Seattle-Tacoma corridor may serve a small, dense service area with same-day visit capacity, while an agency covering a rural county in eastern or northern Washington may drive well over an hour each way to reach a single patient.

That travel time is not a small detail. It shapes how quickly a nurse can respond to a crisis call at 2am, and how realistic a same-day visit is when a family needs one. Families in eastern Washington's rural counties, and communities served jointly with tribal or Indian Health Service systems, may have fewer agency choices to begin with, and it is reasonable to ask a hospice directly what its average response time looks like for a household in that specific area, and how it coordinates with a patient's existing tribal health provider if one is involved. Mountain pass closures in winter are also worth asking about for any household near a pass route, since they can delay a scheduled visit by hours.

How Apple Health fits into hospice coverage in Washington

Washington's Medicaid program, Apple Health, covers hospice care for enrollees who meet the same terminal-illness criteria Medicare uses, and because Washington was one of the states that expanded Medicaid eligibility in 2014, more Washington adults qualify for Apple Health coverage than in a neighboring state that did not expand. For a family weighing coverage options, that expansion is part of why hospice access in Washington looks different than it does elsewhere.

For someone living in a nursing facility who is enrolled in both Medicare and Apple Health, Medicaid typically pays the facility a room-and-board rate, commonly close to 95 percent of what the facility would otherwise charge, passed through the hospice rather than billed directly to the family, though the exact mechanics can vary by circumstance 6Ref 6Centers for Medicare & Medicaid Services (2024).Hospice Payments (Medicaid).Supports how Medicaid room-and-board payment works for a hospice patient who is also a nursing facility resident.. Any hospice serving a dually eligible patient in a Washington nursing facility should be able to explain this arrangement clearly and in writing before a family signs anything.

Questions worth asking before choosing

A short, direct list of questions, asked of any hospice under consideration, does more than a long comparison spreadsheet: - What is your CAHPS Hospice Survey score, and how many family responses is it based on? - What is your live discharge rate, and what usually causes a live discharge here? - Are you for-profit or nonprofit, and how long has your leadership team been in place? - What is your average response time for an urgent call in my specific area, not the county average? - If I live in a rural part of the state, will the same nurse and aide visit consistently, or does that depend on who is available that day? - How do you coordinate with Apple Health or a nursing facility's billing if that applies to my family member?

A hospice that answers these plainly, with specific numbers rather than reassurance, is telling a family something real about how it operates.