You have the right to choose your hospice. Not the hospital’s preferred one, not the nursing home’s usual one. Yours. Metro Detroit has dozens of Medicare-certified hospices, and while all of them must meet the same federal standards, they differ in how they answer the phone at night, how quickly a nurse shows up, and how they treat your family after the death. The questions below will help you tell them apart. Ask two or three hospices the same questions and compare the answers. It takes an hour and it matters.

Before you start: two things to know

You can choose any Medicare-certified hospice. A hospital discharge planner or facility social worker may hand you a list or suggest one. That is fine, but you are not obligated. Tell them which hospice you want, and they will make the referral.

Every Medicare-certified hospice must provide the same core services. Nursing, aide care, social work, chaplain, volunteers, medications and equipment related to the terminal illness, four levels of care, and bereavement support. So the question is not “what do they offer” so much as “how well and how reliably do they do it.”

The 12 questions

1. Are you Medicare-certified?

Start here. Medicare certification means the hospice meets federal Conditions of Participation, is surveyed regularly, and can bill Medicare and Medicaid. If a hospice is not Medicare-certified, Medicare will not pay for its care. Nearly all hospices in Michigan are certified, but ask anyway, and ask how long they have been.

2. Are you accredited, and by whom?

Accreditation is voluntary and goes beyond the Medicare minimum. The main accrediting bodies for hospice are ACHC (Accreditation Commission for Health Care), The Joint Commission, and CHAP. An accredited hospice has invited an outside organization to inspect its clinical practices and safety procedures against a published standard. It is not the only measure of quality, but it is a meaningful one.

3. Who answers the phone after hours?

This one separates hospices more than almost any other. When you call at 11 p.m. because your mother is in pain, does a nurse from the hospice answer? An answering service that pages someone? A call center in another state? Ask specifically: “If I call at 2 a.m., who picks up, and how quickly will I speak to a nurse?”

4. How fast can a nurse get to us after hours?

Phone advice is helpful, but sometimes you need a person in the room. Ask what their target response time is for an after-hours visit and whether they have on-call nurses covering your area. A hospice based in Wayne County may cover Rochester Hills, but ask how long the drive really is at night.

5. How do you handle a crisis at 2 a.m.?

Walk them through a scenario. “My father is suddenly very short of breath and agitated. It is 2 a.m. What happens?” A good answer includes: a nurse on the phone immediately, medications already in the home for exactly this situation (often called a comfort kit), a nurse dispatched if needed, and a clear plan to avoid an ambulance and ER unless that is what the family wants. If the answer is “call 911,” keep looking.

6. How many patients does each nurse care for?

Hospices do not all staff the same way. Ask about typical nurse caseloads in general terms. Lower caseloads usually mean longer visits and more flexibility when things change. There is no single right number, and it varies by how spread out patients are, but a hospice should be able to give you a straight answer and explain how they decide visit frequency.

7. Do you actually provide continuous home care?

Medicare requires every hospice to offer continuous home care, which is extended hours of mostly nursing care in the home during a symptom crisis. In practice, some hospices staff it readily and some rarely use it. Ask: “When a patient at home has uncontrolled symptoms, how often do you provide continuous care, and how quickly can you start it?” This is the level of care that keeps people at home when things get hard.

8. Where do you provide inpatient and respite care?

Every hospice must be able to arrange general inpatient care for uncontrolled symptoms and inpatient respite so caregivers can rest. Ask where. Some hospices operate their own inpatient units; many contract with hospitals or nursing facilities. Ask which facilities they use near you and how quickly a bed can be arranged. See Hospice at Home or in a Facility? for how these levels work.

9. How long does bereavement support last, and what does it include?

Medicare requires hospices to offer bereavement services to families for up to a year after a death. What that looks like varies widely: phone calls, mailings, support groups, one-on-one counseling, memorial events. Ask what they provide, who provides it, and whether it is available to the whole family, including children.

10. Do you have a volunteer program?

Medicare-certified hospices are required to use trained volunteers. A strong volunteer program means companionship visits, help with errands, a break for the caregiver, and sometimes specialized volunteers such as veterans who visit veterans or musicians. Ask how many active volunteers they have and what volunteers actually do.

11. What do you offer veterans?

Roughly one in four deaths in the United States is a veteran. Many hospices participate in the We Honor Veterans program, a partnership between the National Alliance for Care at Home and the VA, which trains staff on veteran-specific needs and provides recognition ceremonies. Ask whether they participate, whether they help families access VA benefits, and whether they have veteran volunteers. If your father served, this matters more than you might expect.

12. Can we switch hospices if it is not working?

Yes, and a hospice should say so plainly. Under Medicare, a patient can change hospices once during each benefit period without losing the benefit. Benefit periods are two 90-day periods followed by unlimited 60-day periods. The new hospice handles the transfer paperwork. A hospice that discourages you from asking this question is telling you something.

Use Care Compare on medicare.gov

Medicare publishes quality data on every certified hospice at
medicare.gov/care-compare. Search by your ZIP code, choose “hospice,” and you can see:

  • Family caregiver survey results (the CAHPS Hospice Survey), covering communication, timely help, treating the patient with respect, and whether the family would recommend the hospice
  • Quality measures such as how often patients receive visits from a nurse or social worker in the last days of life
  • Ownership type and years certified

Care Compare is not perfect. Newer hospices may not have enough data yet. But it is independent, public, and worth twenty minutes. Bring anything surprising to the hospice as a question.

Other ways to compare

  • Ask the facility nurses, not just the administrator. If your mother is in a nursing home, the aides see every hospice that walks through the door. They know who shows up.
  • Call each hospice and notice how the call feels. Did a person answer? Did they listen before they pitched?

Being fair to all of them

Metro Detroit has large national hospice chains, hospital-affiliated hospices, nonprofit hospices, and small family-owned ones. Each model has strengths. Larger organizations may have their own inpatient units and deep resources. Smaller ones may offer more consistency in who walks through your door. Nonprofit status does not by itself guarantee better care, and for-profit status does not by itself mean worse. Ask the questions, check Care Compare, and trust what you hear.

How Lily handles this

Lily Hospice is family-owned, Medicare-certified, and ACHC-accredited, and serves Oakland, Macomb, and Wayne counties from our office in Troy. Our 24/7 phone line is answered by a real person, not an answering service. We provide all four levels of care, including continuous home care, and we arrange inpatient and respite stays when needed.

We support veterans through a Veteran Advisory Committee and a Veteran Rapid Response program, and we are working toward participation in the VA Community Care Network. Our bereavement support continues for families after a death. We offer trained volunteers and the Journey Program, which brings virtual reality experiences to patients.

Ask us all twelve questions. We would rather you choose well than choose fast.

Frequently asked questions

Do I have to use the hospice the hospital recommends? No. You may choose any Medicare-certified hospice. Tell the discharge planner which one you want.

How many hospices should I call? Two or three is plenty. Ask each the same questions and compare.

Can we change hospices later? Yes, once per benefit period under Medicare. The new hospice manages the transfer.

Does a nonprofit hospice provide better care? Not automatically. Ownership type does not determine quality. Use Care Compare, ask questions, and talk to people who have used them.

What if the hospice we chose is not responsive? Raise it with them directly first; most problems are fixable. If not, you can transfer to another hospice once per benefit period.

Talk to us

Choosing a hospice is one of the last big decisions you will make for someone you love. Take the time. When you are ready to ask your questions, call Lily Hospice at (248) 955-5100, any time, and a real person will answer. Or contact us online.

Written and reviewed by the Lily Hospice clinical team.

Sources

  • Medicare.gov, Care Compare (hospice search): https://www.medicare.gov/care-compare/
  • Medicare.gov, “Medicare Hospice Benefits” (CMS Product No. 02154), including the right to change hospices: https://www.medicare.gov/publications/02154-medicare-hospice-benefits.pdf
  • CMS, Hospice Quality Reporting Program: https://www.cms.gov/medicare/quality/hospice
  • National Alliance for Care at Home, We Honor Veterans: https://www.wehonorveterans.org/