For-Profit vs. Nonprofit Hospice: Does It Matter?

Does it matter if a hospice is for-profit or nonprofit?

When you are choosing care for a dying parent or spouse, the fear behind this question is simple: will they cut corners on my loved one? That is fair to ask. You are right to look closely.

The honest answer: the label can matter, but it is not the whole story. About 80 out of every 100 U.S. hospices are now for-profit 3Ref 3Medicare Payment Advisory Commission (MedPAC) (2025).Hospice Services (Chapter 9), Report to the Congress: Medicare Payment Policy.Census-level 2023 hospice statistics: median stay 18 days vs mean 96.2 days, >25% enroll in the last week of life, 18.5% live-discharge rate, ~80% of hospices for-profit, and the ~3.9 visits/week routine-home-care reality.. Some are excellent. Some are not. The same is true of nonprofits. The label tells you where to look harder — it does not decide for you. Start with the basics in how hospice care works.

What does the research show?

The largest look comes from a national survey of families whose loved one had died in hospice care. More than 650,000 answered 24Ref 24Anhang Price R, et al. (RAND) (2023).Association of Hospice Profit Status With Family Caregivers' Reported Care Experiences.CAHPS Hospice Survey analysis of 653,208 caregiver respondents across 3,107 hospices: for-profit hospices scored worse across all care-experience domains and were about 5 points less likely to be 'definitely recommended.'. On average, they rated for-profit hospices lower than nonprofit ones on every measure of care. They were also about 5 points less likely to 'definitely recommend' them 24Ref 24Anhang Price R, et al. (RAND) (2023).Association of Hospice Profit Status With Family Caregivers' Reported Care Experiences.CAHPS Hospice Survey analysis of 653,208 caregiver respondents across 3,107 hospices: for-profit hospices scored worse across all care-experience domains and were about 5 points less likely to be 'definitely recommended.'.

That is a real and steady pattern. But it is an average across more than 3,000 hospices 24Ref 24Anhang Price R, et al. (RAND) (2023).Association of Hospice Profit Status With Family Caregivers' Reported Care Experiences.CAHPS Hospice Survey analysis of 653,208 caregiver respondents across 3,107 hospices: for-profit hospices scored worse across all care-experience domains and were about 5 points less likely to be 'definitely recommended.'. It does not tell you about the one in your town. A strong for-profit hospice can beat a weak nonprofit. The average hides both. Use the label to raise your guard, not to pick for you.

Why the gap exists, told plainly

Money pressure can pull against care in a few ways. It can mean fewer nurses on staff. It can mean fewer visits each week. It can mean signing up people who are not truly near death, to fill beds. News investigations have found for-profit chains that chased numbers over care 23Ref 23Kofman A (ProPublica, co-published with The New Yorker) (2022).Endgame: How the Visionary Hospice Movement Became a For-Profit Hustle.Investigative evidence of for-profit hospice fraud — enrollment quotas, recruiting non-dying patients, and regulatory failure — supporting the case that choosing a hospice carefully matters..

This is why researchers point to the profit motive, not to bad people. Most staff in both kinds work hard; the worry is the pressure above them. And it is only a pattern, not a verdict. It does not mean any one for-profit hospice is bad. It is a reason to ask plain questions and check the record before you choose.

What matters more than the profit label

When you compare hospices, these tell you more than the profit label:

• Staffing at night and on weekends — who actually comes when things get hard. A Medicare hospice must keep a nurse and doctor on call 24 hours a day, 7 days a week 2Ref 2Centers for Medicare & Medicaid Services (2023).Medicare Hospice Benefits (CMS product 02154).Official CMS booklet: every Medicare hospice has a nurse and doctor on call 24 hours a day, 7 days a week, and a patient may change their hospice provider once during each benefit period. — ask who that is.
• How fast they answer an after-hours call, and whether a nurse can come to the home.
• A plan for a crisis — continuous care or an inpatient bed, for when symptoms spike and home care is not enough.
• Live-discharge rate — how often they discharge patients who are still alive. About 18 in 100 is the national average 3Ref 3Medicare Payment Advisory Commission (MedPAC) (2025).Hospice Services (Chapter 9), Report to the Congress: Medicare Payment Policy.Census-level 2023 hospice statistics: median stay 18 days vs mean 96.2 days, >25% enroll in the last week of life, 18.5% live-discharge rate, ~80% of hospices for-profit, and the ~3.9 visits/week routine-home-care reality.. A much higher rate is worth asking about.
• Grief support for the family in the months afterward.

You can look up any hospice's quality scores on Medicare's Care Compare tool. For more, see how to choose a hospice, the questions to ask when choosing a hospice, and how many visits a week hospice provides.

Cost, coverage, and your own situation

The Medicare benefit is the same for both. The covered services and small copays do not change with the profit label, and room and board is not covered either way 1Ref 1Centers for Medicare & Medicaid Services (2026).Hospice Care Coverage.Medicare hospice benefit mechanics: two-physician certification of a 6-month prognosis, the covered services and small copays, and that room and board is not covered — all identical regardless of a hospice's profit status.. Medicare, Medicaid, and most private plans all cover hospice on similar terms 33Ref 33National Institute on Aging (NIH) (2026).What Are Palliative Care and Hospice Care?.Authoritative plain-language explanation of hospice and palliative care, including that hospice is covered by Medicare, Medicaid, and most private insurance plans.. So cost rarely decides between the two.

Often there is only one hospice near you. In many rural areas the choice is not for-profit versus nonprofit — it is one hospice or none. Then the question is how to vet the only option. Vet it the same way: staffing, speed, and record.

A harder illness means more to ask. The profit label does not change with the diagnosis. But a loved one with dementia, or hard-to-control pain, needs a hospice staffed for it. Ask how often they treat that illness, and what they do in a crisis.

Trust is not shared evenly. Black and Hispanic families use hospice less than white families 27Ref 27 (2022).Racial and Ethnic Differences in Hospice Use and Hospitalizations at End-of-Life Among Medicare Beneficiaries With Dementia.Among dementia decedents, Black (38.2%) and Hispanic (42.9%) Medicare beneficiaries used hospice less than White (50.5%) beneficiaries, with more end-of-life ED and inpatient care and far lower advance-care-planning completion., in part from real, earned mistrust of the medical system. Careful vetting matters more, not less, when trust is strained. A good hospice honors your family's faith — chaplain and clergy support are part of the care.

How to compare fast, and what to bring

Most families do not have weeks to shop. The middle hospice stay is only about 18 days, and more than 1 in 4 people start hospice in their last week of life 3Ref 3Medicare Payment Advisory Commission (MedPAC) (2025).Hospice Services (Chapter 9), Report to the Congress: Medicare Payment Policy.Census-level 2023 hospice statistics: median stay 18 days vs mean 96.2 days, >25% enroll in the last week of life, 18.5% live-discharge rate, ~80% of hospices for-profit, and the ~3.9 visits/week routine-home-care reality.. So compare quickly — but do compare.

When you call, the intake nurse will ask about the illness, the symptoms, the medicines, and who the doctor is. To make that call go faster, have these ready:

1. A list of current medicines and doses. 2. The main diagnosis, and the doctor treating it. 3. The Medicare or insurance card. 4. Any advance directive, POLST, or DNR form.

After you choose, two doctors must agree the person is likely in their last 6 months of life 1Ref 1Centers for Medicare & Medicaid Services (2026).Hospice Care Coverage.Medicare hospice benefit mechanics: two-physician certification of a 6-month prognosis, the covered services and small copays, and that room and board is not covered — all identical regardless of a hospice's profit status.. Your loved one elects comfort care, and a nurse visits to begin. If it is not working, you can switch to a different hospice once in each benefit period 2Ref 2Centers for Medicare & Medicaid Services (2023).Medicare Hospice Benefits (CMS product 02154).Official CMS booklet: every Medicare hospice has a nurse and doctor on call 24 hours a day, 7 days a week, and a patient may change their hospice provider once during each benefit period..

Questions to bring to your visit

Bring these to each hospice you are considering. Start with the one that matters most to you.

• Are you for-profit or nonprofit, and how are you rated on Care Compare?
• Who comes to the home at night and on weekends?
• How fast do you answer an after-hours call, and can a nurse come out?
• What do you do when symptoms spike — do you offer continuous care or an inpatient bed?
• What is your live-discharge rate, and why?
• What grief support do you offer the family afterward?