Understanding Hospice Care
Levels of Hospice Care Explained
Learn about routine, continuous, inpatient, and respite hospice care, including when each level may be used.
Read guide →Understanding Hospice Ratings & Quality Information
Learn how Medicare ratings, family surveys, reviews, and accreditations can help you choose a hospice provider.
Written and reviewed by Dr. G, a board-certified hospice & palliative medicine physician
Last reviewed:
12 min read
When choosing a hospice, families may see star ratings, percentages, reviews, and accreditation logos. These come from different sources and measure different parts of the hospice experience.
Understanding what each one means—and what it does not mean—can help you make a more confident decision.
Key point: Medicare does not publish a single "overall quality score" for hospice care. Each rating reflects a specific perspective and should be considered together.
Medicare Star Rating (Family Experience)
CMS formal name: Family Caregiver Survey Rating (Care Compare)
What we call it on our site: Medicare Star Rating (Family Experience)
What this rating measures
This is the only star rating Medicare publishes for hospices. It reflects how family caregivers rated their experience with a hospice, based on responses to the national CAHPS Hospice Survey.
The rating summarizes family feedback across multiple experience areas, including:
- •Communication with the hospice team
- •Getting timely help
- •Emotional and spiritual support
- •Respect and dignity shown to the patient
- •Help with pain and symptom management
How the star rating is calculated
After a patient dies while receiving hospice care, a family caregiver may be invited to complete the standardized CAHPS Hospice Survey.
CMS combines several adjusted family-experience measures and uses national rating thresholds to assign a summary rating of 1 to 5 stars.
A hospice must be eligible for public reporting and have at least 75 completed surveys during the eight-quarter—or approximately two-year—reporting period to receive a star rating.
Why some hospices don't have a star rating
A hospice may not display a Medicare Star Rating (Family Experience) because:
- •It did not have at least 75 completed surveys during the reporting period
- •It is newer or serves a smaller number of patients
- •It qualified for a CMS survey exemption
- •It was not eligible for public reporting during that period
Important: A missing star rating does not mean the hospice received poor ratings or provided poor care. It means CMS did not publish enough information to calculate a reliable star rating for that reporting period. A missing rating should not be interpreted as zero stars.
Limitations
This rating reflects family experience, not clinical outcomes. It does not measure staffing levels, visit frequency, or medical results. Ratings are updated periodically and may not reflect very recent changes.
CAHPS Family Survey
CMS formal name: Willing to Recommend this Hospice
What we call it on our site: CAHPS Family Survey
What this score shows
This score reflects one specific question from the national CAHPS Hospice Survey:
The percentage of family caregivers who gave the most favorable response when asked whether they would recommend this hospice.
CMS reports this as a percentage (0–100%).
Example: "Families who would definitely recommend this hospice: 92%"
This means that 92% of responding family caregivers selected the most positive answer.
How this differs from the star rating
- •It reflects a single survey question, not a summary of all experience measures
- •It provides a clear, direct signal of family recommendation
- •Public reporting requires at least 30 completed surveys
Why this percentage may appear without a star rating
CMS generally requires at least 30 completed surveys during the eight-quarter—or approximately two-year—reporting period to publish this recommendation percentage.
The Medicare Star Rating requires at least 75 completed surveys. Therefore, a hospice with 30 to 74 completed surveys may have a published family recommendation percentage but no star rating.
If this score is unavailable, that does not mean families reported a poor experience. CMS may simply not have enough completed surveys to publish the result reliably.
Limitations
The score reflects family perceptions and experiences. Response rates can be limited due to the emotional timing of the survey. Results are reported after care ends, so there is a time delay.
Hospice Care Index (HCI)
CMS formal name: Hospice Care Index (HCI)
What we call it on our site: Hospice Care Index (HCI)
What this score shows
The Hospice Care Index is a Medicare score from 0 to 10 based on claims data—not family surveys. It helps answer:
“Do this hospice’s records show generally sound patterns of care across the full hospice stay?”
Medicare examines ten areas, including nursing visits, crisis care, visits near the end of life, hospital transitions, live discharges, and spending. The hospice earns one point for each criterion it meets. A score of 9 means it met 9 of the 10 criteria—it does not mean the hospice provided “90% good care.”
How to use this score
- •Higher scores are generally better.
- •A notably low score may be a reason to ask additional questions.
- •Don’t automatically select a hospice scoring 10 over one scoring 9.
- •A missing score often means Medicare does not have enough data, especially for a newer or smaller hospice. It does not necessarily indicate poor care.
What this score does not tell you
The HCI cannot tell you how compassionate, communicative, or responsive a hospice’s staff will be. It also cannot fully show how well the hospice manages an individual patient’s symptoms or supports their family. Because it uses historical claims, it may not reflect recent changes at the organization.
Why some hospices don't have an HCI score
CMS does not assign an HCI score when a hospice has fewer than 20 discharges across the two-year reporting period.
This is more common among newer or smaller hospices. A missing HCI score does not mean the hospice performed poorly; it means CMS did not have enough qualifying claims data to calculate a reliable score.
How it fits with other ratings
Use the HCI alongside the CAHPS Hospice Star Rating, individual family survey results, services offered, reviews, and your conversations with the hospice. HCI shows patterns found in Medicare records; CAHPS shows what families reported experiencing. Together, they provide a more complete picture.
Other Medicare Hospice Quality Information (No Stars)
Medicare reports additional hospice quality information separately on Care Compare.
Hospice Quality Reporting Program (HQRP)
HQRP is the Medicare program that collects hospice quality data, including:
- •CAHPS survey results
- •Claims-based measures
- •Clinical data submissions
HQRP is not a rating and does not produce a single score.
Google Reviews
What they are
Google Reviews are voluntary, public reviews left by families and others on Google Business profiles.
They may include:
- •Personal stories and experiences
- •Recent feedback
- •Comments about staff, communication, or responsiveness
- •A 1–5 star average
Limitations
Reviews are not standardized or verified. People with very positive or very negative experiences are more likely to leave reviews. Review counts vary widely between hospices.
Tip: Look for consistent themes across reviews rather than focusing on a single comment.
Accreditations and Certifications
Medicare Certified (Required)
All hospices serving Medicare patients must:
- •Meet federal hospice requirements
- •Undergo regular state surveys
- •Comply with patient rights and safety standards
This is the minimum requirement for providing hospice care.
ACHC — Accreditation Commission for Health Care
- •Voluntary accreditation
- •Indicates compliance with additional quality and operational standards
- •Typically renewed every three years
CHAP — Community Health Accreditation Partner
- •Voluntary accreditation
- •Focuses on quality improvement and organizational accountability
- •Typically renewed every three years
We Honor Veterans
National program focused on veteran-centered hospice care. Recognizes hospices through progressive participation levels. Indicates training and programs to support veterans and their families.
Key Takeaways
- •The Medicare Star Rating (Family Experience) summarizes family experience across multiple survey questions
- •The CAHPS Family Survey shows how often families would recommend the hospice
- •Missing ratings don't automatically indicate poor quality
- •Accreditations are voluntary and complementary
- •Speaking directly with a hospice team remains essential
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