A Side-by-Side Method for Two Hospices

What is the fastest honest way to compare two hospices?

Three steps: paper, phone, weigh. First, open both agencies on Medicare's Care Compare, the official public tool for comparing Medicare-certified hospices on quality measures and family-experience scores 1Ref 1Centers for Medicare & Medicaid Services (2024).Find Healthcare Providers: Compare Care Near You (Hospice).Care Compare is the official public tool for comparing Medicare-certified hospices on quality measures and CAHPS family-experience scores, searchable by location and shown with benchmark context.. Second, call both hospices with the same short list of questions and write down the answers verbatim. Third, weigh what the two sources say together, letting disagreement between them count as information.

The order matters. Reading the public data first means the phone call can probe weaknesses — a low communication score becomes a pointed question about who calls the family back, and how fast. Doing it in the other order turns the call into a sales conversation, because the agency chooses what to talk about.

Everything below assumes both hospices serve the address where care will happen. If only one does, the comparison is already over, and the remaining work is vetting a single agency.

Step one: put both agencies on the same screen

Care Compare lists every Medicare-certified hospice with its publicly reported quality data, searchable by ZIP code, and it displays results next to state and national averages so a number has context 1Ref 1Centers for Medicare & Medicaid Services (2024).Find Healthcare Providers: Compare Care Near You (Hospice).Care Compare is the official public tool for comparing Medicare-certified hospices on quality measures and CAHPS family-experience scores, searchable by location and shown with benchmark context.. The most useful part of the profile is the family survey.

Those survey results come from the CAHPS Hospice Survey, which asks the primary caregivers of patients who died — surveyed in the months after the death — about specific domains: whether the patient got help for pain and symptoms, whether the team communicated well, whether help came in a timely way, how they rate the hospice overall, and whether they would recommend it 2Ref 2Centers for Medicare & Medicaid Services (2024).CAHPS Hospice Survey.The CAHPS Hospice Survey samples primary caregivers of deceased hospice patients months after the death and measures domains including symptom help, communication, timeliness, overall rating, and willingness to recommend.. These are not marketing metrics. They are the recollections of the families who were most recently in the position the reader is in now.

A practical way to read two profiles side by side:

• Note direction, not decimals. The question is whether each agency sits above or below its state average, measure by measure. A one-point difference between the two hospices means little; one agency above the benchmarks and one below means a lot.
• Look for a pattern across domains. An agency below average on communication, timely help, and willingness to recommend is describing itself. A single soft score amid strong ones is a smaller signal.
• Write the numbers down. The phone script in step three comes directly from whatever looked weak on paper.

Step two: check the signals the research says predict trouble

Two findings from the hospice literature convert directly into comparison criteria.

Ownership. In national family-survey data, caregivers reported worse experiences at for-profit hospices than at not-for-profit hospices across all measured domains, and were 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.Family caregivers report worse experiences at for-profit hospices across all measured domains and are less likely to recommend them, making ownership a legitimate tie-breaker between otherwise even agencies.. This is an average, not a verdict on either of your two agencies — a strong for-profit beats a weak nonprofit — but when everything else looks even, it is a legitimate tie-breaker, and it sharpens the reading of each agency's scores: a for-profit scoring above its state average has already rebutted the presumption.

Live-discharge behavior. Problematic patterns of patients leaving hospice alive are far more common at for-profit than not-for-profit hospices 4Ref 4Teno JM, Plotzke M, Christian T, Gozalo P (2015).Characteristics of Hospice Programs With Problematic Live Discharges.Problematic live-discharge patterns are far more common at for-profit than not-for-profit hospices, which is why live-discharge behavior belongs among the comparison criteria., and patients discharged alive face a higher chance of burdensome transitions — hospitalization, readmission, death in a hospital — when the discharging hospice was for-profit and the stay was short 5Ref 5Peer-reviewed cohort study (see article) (2024).Hospice Readmission, Hospitalization, and Hospital Death Among Patients Discharged Alive from Hospice.Patients discharged alive from hospice more often experience burdensome transitions — hospitalization, readmission, hospital death — when the discharging hospice was for-profit and the stay was short.. Live discharge is therefore a fair, revealing question to put to both agencies directly: how often do patients leave your service alive, and why? The quality of the answer matters as much as the number in it.

The fuller method for judging hospice quality — every public signal, and what each is worth — is its own page; for a two-way comparison, these two carry the most discriminating power per minute spent.

Step three: ask both hospices the same five questions

Identical questions, asked in the same order, written down verbatim. The symmetry is the method — it is the only way the answers can be compared rather than the salesmanship.

1. Who answers your phone at 3am, and what happens next? The useful answer names a role (a nurse, not an answering service reading a script) and a time (how long until a callback, how long until a visit if one is needed). 2. How often will a nurse and an aide actually visit, and how does that change in the last days? Vague answers ("as often as needed") are a flag; good agencies describe a typical week and how it escalates. 3. Medicare requires four levels of hospice care — routine home care, continuous home care during a crisis, general inpatient care when symptoms can't be managed at home, and respite care for up to five consecutive days 6Ref 6Centers for Medicare & Medicaid Services (2024).Medicare-Certified 4 Levels of Hospice Care.Medicare hospice includes four levels of care — routine home care, continuous home care during crises, general inpatient care for symptoms unmanageable elsewhere, and inpatient respite care up to five consecutive days — which every agency must be asked to explain concretely.. How do you deliver each one? The revealing follow-up: where is the general inpatient bed, and how fast can a patient be moved to it? 4. How often do patients leave your service alive, and for what reasons? See step two for why this question earns its place. 5. Who owns this agency, and has that changed in the last few years? A plain answer is the point; hedging is information.

One more comparison happens without a question: which agency answered the phone, how long the hold was, and whether the person on the line spoke like a clinician or a closer. The first phone call is a free sample of every future 3am call.

A comparison sheet worth filling in

One page, two columns. The rows below cover both the paper record and the phone answers.

Agencies rarely sweep the sheet. The usual result is a lean — one agency stronger on paper, the other on the phone — which the last section takes up.

How to weigh a split decision

When paper and phone disagree, the phone call usually deserves more weight, for two reasons. Survey scores describe the past — families served over previous years, possibly under previous staffing or previous owners — while the phone call samples the present. And the phone answers are about the specific thing being purchased: response times, visit patterns, and inpatient arrangements for this address, this month.

But a bad paper record is never erased by a good call. Recruiting staff are often the most polished people at a weak agency. When an agency's family survey sits below average across several domains 2Ref 2Centers for Medicare & Medicaid Services (2024).CAHPS Hospice Survey.The CAHPS Hospice Survey samples primary caregivers of deceased hospice patients months after the death and measures domains including symptom help, communication, timeliness, overall rating, and willingness to recommend. and the call is charming, the honest reading is that past families experienced something the charm did not fix. In that split, the paper wins.

When both sources genuinely tie, smaller things decide reasonably: which agency is physically closer (drive time is response time), which one volunteered information before being asked, which nurse asked questions about the patient rather than answering only about the agency. A tie between two strong hospices is a good problem — both are acceptable, and the cost of the choice is low.

Where you live changes the comparison

The method is the same everywhere, but the market is not — some counties offer a dozen hospices and some offer one, and the mix of ownership types varies city by city. Local guides apply this same worksheet to a single market, with the area's context filled in: hospice quality in Indianapolis, IN; hospice quality in Portland, OR; hospice quality in Boston, MA; hospice quality in Charlotte, NC; and hospice quality in Chicago, IL.

Wherever the comparison happens, the endpoint is the same: two columns, filled in from public data and two phone calls, that turn a coin-flip between brochures into a decision a family can explain to itself afterward. That explanation matters. Families who can say why they chose carry the choice more lightly in the months that follow.