Questions to Ask During a Hospice Interview
Questions to ask during a hospice interview, from the family's side of the table: the meeting where you decide whether this is the agency you want coming to the house. This page is for families working out what questions to ask a hospice provider before signing on with one, not for job candidates. The list runs in six parts: the agency and its team, getting started, nights and crises, comfort, costs, and support for the family through the last days and afterward. If the nurse or aide who would visit is at the meeting, the first part also holds questions to ask hospice caregivers directly, about what a visit covers and what an aide may and may not do. Coverage details follow US Medicare, and where a rule depends on your state or your plan the note says to ask how it works for you. If you are comparing two hospices, put the same questions to both and write the answers side by side.
The questions
Each question, and why to ask it
Agency and team
Are you Medicare certified, and are you accredited by an outside body?
Why ask it
Medicare certification is the baseline: without it Medicare will not pay for the care. Accreditation by an independent organization is voluntary and state licensing rules differ, so follow up with who last inspected them and whether you can see what was found.
How long have you served this area, and are you nonprofit or for profit?
Why ask it
Neither ownership type is automatically better, so treat the answer as a lead-in: do they turn away complicated cases, and do they have inpatient beds of their own? An agency with years in the area tends to know the local hospitals, nursing homes and pharmacies by name.
Who will be on the care team, and what does each person do?
Why ask it
A hospice team normally includes a nurse, an aide, a social worker, a chaplain, a physician and volunteers. Which of them you will actually meet in the first week is the better question, because a team on paper and a team at the door are not always the same.
How often will a nurse visit in a typical week, and how long does a visit last?
Why ask it
Hold out for a number. 'As needed' cannot be compared between two agencies, and twice a week for an hour can. Write it down, because it is the figure you will come back to if the visits start thinning out.
Will the same nurse and aide come each time?
Why ask it
A nurse who saw the patient last Tuesday notices that the breathing has changed, and a stranger has nothing to compare it with. If the answer is vague, ask what their staff turnover has been over the past year.
How many days a week will an aide come to help with bathing and personal care?
Why ask it
Aide time is the help families feel first, and it often comes to a few short visits a week, not daily care. Knowing the real figure early lets you line up relatives or a private aide for the other days before the gap shows up midweek.
How many patients is each nurse case manager responsible for at one time?
Why ask it
A number is the only useful answer here, and a long pause is an answer too. Heavier caseloads generally mean shorter visits and slower callbacks, which is why the same question belongs in the second agency's interview.
Are the nurses and aides your own employees, and how do you screen and train them?
Why ask it
An agency that leans on contract or per-visit staff may find it harder to send the same person twice. Background checks matter for anyone who will be alone in the house with the patient, and it is fair to ask whether any of the nurses hold the optional hospice and palliative care certification.
Can we meet the nurse or aide who would be assigned to us before we decide?
Why ask it
Assignments are often made only after admission, so not every agency can arrange this, and a refusal is not a mark against them. If they can, ten minutes with the person who would be doing the visits is worth having before you sign.
What does a routine visit look like, from the moment the nurse arrives to the moment they leave?
Why ask it
Put this to the nurse directly if one is in the room. A full answer covers more than vital signs: the skin, the medication supply, how the person doing the caregiving is coping, and time left over for whatever the family has saved up to ask.
What will the aide do on a visit, and what is an aide not allowed to do?
Why ask it
Bathing, dressing and changing the bed are the usual work. Whether an aide may give medicines or adjust equipment depends on state rules and the agency's own policy, so have them spell it out for where you live before you plan a day around it.
Who supervises the aides, and how often does a nurse check on their work in the home?
Why ask it
Certified hospices are expected to have a nurse review each aide's work on a regular schedule, so the agency should be able to name it without looking it up. The supervising nurse is also the person to speak to when the aide is kind but something about the care needs adjusting.
How do the nurse and aide pass on what they saw during a visit, to each other and to us?
Why ask it
An aide giving a bath is often the first to see a red patch of skin or a new wince, and that needs to reach the nurse the same day. Agencies do this through a shared chart, a note left in the house or a phone call, and the family member who was at work should not be the last to hear.
If a nurse or aide is not a good match for the patient, can we ask for someone else?
Why ask it
A person being bathed in their last months has to be at ease with whoever is doing it, and sometimes they are not. The request should be treated as routine: listen for who you would phone, and whether a change would mean a wait or fewer visits in the meantime.
Who is the physician overseeing care, and will our own doctor stay involved?
Why ask it
The hospice medical director oversees the plan, and under Medicare the patient can usually name their own doctor as the attending physician if that doctor agrees. Settle it at admission, because otherwise a longtime doctor can drop out of the picture without anyone having chosen that.
How many patients with this diagnosis have you cared for, and what do you do differently for them?
Why ask it
Dementia, heart failure, lung disease and cancer each run a different course, and a team that knows this one can describe what the coming months tend to look like. A reply that would fit any illness means you are getting the general pitch.
Where can we see your quality scores and what families said about you afterward?
Why ask it
Medicare publishes quality measures and family survey results for certified hospices on its Care Compare site, so an agency can point you straight to its own page. Look at how families rated communication and help with pain, and bring up any score that sits well below the rest.
If we have a complaint about the care, who do we take it to and what happens next?
Why ask it
You are listening for a named person and a timeframe, not a reassurance that complaints are rare. There is also a route outside the agency, and since it differs from state to state, have them write down who that is where you live.
Getting started
How soon after we say yes can care begin, and does that include evenings and weekends?
Why ask it
Families often make this call in a hurry, after a hospital stay or a bad week at home. An agency that can admit within a day, any day of the week, is staffed differently from one that books you in for next Tuesday.
What happens at the admission visit, how long does it take, and what will we be asked to sign?
Why ask it
Expect a nursing assessment, a stack of consent forms and a choice of attending doctor. Getting the election form ahead of time means nobody is reading the fine print for the first time on an exhausting afternoon.
Who decides whether someone qualifies for hospice, and what happens if they live longer than six months?
Why ask it
Under Medicare a doctor certifies that the illness is expected to run six months or less, and care can continue past that point as long as a doctor recertifies it. Some patients stabilize and are discharged, so find out how often that happens here and what help the family gets when it does.
Do we have to sign a do-not-resuscitate order to enroll, and how do you handle advance directives?
Why ask it
Many families assume hospice and a DNR come as a package, so get this agency's policy stated plainly. The forms and the rules behind them differ by state. Bring any living will or healthcare proxy to the meeting, and check where a copy will be kept so the on-call nurse can see it at night.
Do you care for people where they live now, whether that is a house, assisted living or a nursing home?
Why ask it
Most agencies visit all three, but some have a working relationship with certain facilities and none with others. If a move looks likely later, the thing to pin down is whether the same team would follow.
Do you take patients who live alone, or do you require a family caregiver in the home?
Why ask it
Policies differ: some hospices admit a person who lives alone and plan for the day that stops being safe, and others want a named caregiver from the start. If the caregiver is elderly or works full time, say so now, so the plan is built around the hours that are really covered.
Which treatments would have to stop once hospice starts, and which can carry on?
Why ask it
Agencies set their own policies on things like transfusions, dialysis, tube feeding and radiation given for comfort. If one of these matters to the patient, raise it now, because it can be the deciding difference between two otherwise similar hospices.
How is the plan of care written, and how much say do we get in it?
Why ask it
The plan sets the visits, the medications and the goals, and the team is expected to review it regularly. A good answer has the patient's wishes going into it in their own words, plus a way for the family to request a review between team meetings.
What happens if we want to go back to the hospital, or pursue treatment again?
Why ask it
Under Medicare a patient can revoke the hospice benefit, return to standard care and enroll again later. An agency that explains this without discouraging it understands that the decision belongs to the patient and family.
If this turns out to be the wrong fit, how would we move to a different hospice?
Why ask it
Changing providers is allowed, though how often depends on the coverage, so have them explain it under yours. Watch how the question lands: a calm, practical answer is a better sign than a defensive one.
Nights and crises
Who answers the phone at two in the morning, and is it a nurse with access to the chart?
Why ask it
There is a real difference between an on-call nurse who can see the medication list and an answering service that takes a message. The follow-up is whether a nurse can be sent to the house overnight, and how long that usually takes.
When we phone with a worry, what decides whether we get advice over the phone or a visit?
Why ask it
Some agencies send a nurse whenever the family asks for one, and others triage hard by phone first. Neither is wrong, but you should know which you are signing up for before the first frightening night.
Are weekends and holidays staffed the way weekdays are?
Why ask it
A general yes is easy to give, so make it concrete: how many nurses were on last Sunday, and how many patients were they covering between them? One nurse for a wide area means a long wait when two families call at once.
Does anyone from hospice stay in the house around the clock, and if not, how do other families cover those hours?
Why ask it
Routine hospice care is a series of visits, not a live-in caregiver, and families are often caught out by the gap. A candid agency says so up front and can point you to private aides, volunteer sitters or community programs.
If symptoms get out of control, can you provide continuous nursing at the bedside, and how often have you done that recently?
Why ask it
Continuous home care is one of the four levels of care in the Medicare hospice benefit, so every certified agency can describe it. How many times they provided it last month separates the agencies that staff for it from the ones that only list it in the brochure.
Do you have an inpatient unit or contracted beds, and where are they?
Why ask it
If symptoms cannot be managed at home, someone has to have a bed available, and its location decides how far the family will be driving. Two details to get: who makes the call to move a patient, and how quickly a bed is usually found.
If there is a fall, a seizure or sudden bleeding, do we call you or call 911?
Why ask it
Most hospices ask to be called first, since an ambulance ride can lead to hospital treatment the patient chose to avoid and may raise coverage questions. Whatever they tell you, tape it to the fridge with the phone number before anyone needs it.
What is your plan for a power cut or a storm if the patient depends on oxygen or an electric bed?
Why ask it
Certified hospices are required to have an emergency plan, so this should not catch them off guard. The practical details are what you want: backup oxygen tanks in the house, who phones whom, and whether the patient would be moved.
Comfort
Who manages the medications, and how fast can a new prescription reach the house?
Why ask it
The speed depends on their pharmacy arrangement: a courier, a local pharmacy, or a mail service that is no use on a Friday night. Many hospices also leave a small comfort kit of medicines in the home at admission, so find out what is in it and who gives the go-ahead to open it.
If pain is not controlled, who has authority to change the dose overnight, and how long does that take?
Why ask it
The answer you want is that the on-call nurse can reach a prescriber quickly, at any hour. The one to worry about is that changes wait for the next scheduled visit.
How do you judge pain or distress in someone who can no longer say what hurts?
Why ask it
Nurses read the face, the breathing, muscle tension and restlessness, and many agencies score these on a set scale. Have them show you what they look for, because the family is in the room far more hours than the nurse is.
Apart from pain, which symptoms should we expect with this illness, and what can be done for them at home?
Why ask it
Shortness of breath, agitation, nausea and constipation trouble many patients as much as pain does. A team that walks through each one with a plan is telling you it has managed this illness in a living room before.
Will the pain medicine leave them too drowsy to talk with us?
Why ask it
This is a common fear, and it deserves a straight answer about how doses are started and adjusted. If staying alert matters to the patient, say so, and listen for how the team weighs comfort against wakefulness when the two pull apart.
What happens when they stop eating or drinking, and how will you help us through that?
Why ask it
Appetite often fades as an illness advances, and for many families it is the hardest change to watch. Have the team explain how they approach food, fluids and feeding tubes for this patient, so the conversation has already happened when the day comes.
Will someone go through the current medication list and say which ones are no longer helping?
Why ask it
People often arrive at hospice on a dozen pills, some of them aimed at risks years away. Trimming the list is a normal part of admission, and you can ask for the reason behind each change before agreeing to it.
Who will teach us to give the medicines and do the hands-on care between visits?
Why ask it
At home the family does most of the daily work: repositioning, keeping the mouth moist, measuring out doses. Teaching that is done in person and left behind on paper holds up better at midnight than something explained once on admission day.
Costs
What does the hospice benefit cover, and what will we still be paying for?
Why ask it
Under Medicare the benefit covers care related to the terminal illness, including the medications, equipment and supplies for it. Unrelated prescriptions, room and board in a facility and some treatments are billed elsewhere or to the family, so get the exclusions and any copays in writing.
Do you accept our coverage, whether that is Medicare, Medicaid, a private plan or VA benefits?
Why ask it
Hospice is paid for differently under each one. Medicare Advantage is the one to check closely, since hospice is often billed to original Medicare instead of the plan. Have the agency look at the actual cards and put anything you would owe in writing.
Which of the medicines they take now will you supply, and which stay on our own pharmacy bill?
Why ask it
The hospice pays for drugs tied to the terminal illness and related conditions, and what counts as related is a judgment the agency makes. Go down the list one drug at a time so the first surprise does not come at the pharmacy counter.
What equipment and supplies do you provide, and how soon do they arrive?
Why ask it
A hospital bed, oxygen, a bedside commode and incontinence supplies are common, and delivery timing decides how hard the first few nights are. Same-day delivery on a weekday is one thing, so check what happens when admission falls on a Saturday.
If they live in a nursing home or assisted living, who pays for the room?
Why ask it
Hospice covers the care and not the rent, so room and board usually stays with the family, Medicaid or a long-term care policy. Short inpatient and respite stays arranged by the hospice are handled differently, so go through each one separately.
If we had no coverage, or it lapsed, would you still provide care?
Why ask it
Many hospices, nonprofit ones especially, have charity care or a sliding scale, but the terms are their own. It is an easier conversation before the need arises, and it helps to know which person in the office handles it.
Family and last days
What do the social worker and chaplain do, and can we decline either?
Why ask it
The social worker often handles practical work families do not know to ask for: benefits paperwork, facility placement, funeral planning, family meetings. Chaplain visits are optional, and you can also request someone from your own tradition.
Is respite care available, and how do we arrange it?
Why ask it
Respite is a short inpatient stay for the patient so that a family caregiver can rest, and under Medicare it generally runs up to five days at a time. Get the notice period and the location now, since caregivers tend to raise it only once they are already worn out.
What can your volunteers do for us, and how do we ask for one?
Why ask it
Volunteers can sit with the patient while a caregiver sleeps or runs errands, read aloud, or simply keep company. How long a request takes to fill is the telling detail, since some agencies have a deep bench and others a waiting list.
What do you offer beyond the required services, such as music, massage, pet visits or a veterans program?
Why ask it
These extras are where agencies differ most, and they are often paid for by donations. Pick the one the patient would enjoy and ask how often it really happens, not whether it exists.
Can you work in our language and around our religious or cultural customs for the end of life?
Why ask it
A staff member who speaks the language is a different thing from a phone interpreter, which is harder at a bedside. Describe any customs around washing, prayer or who must be present, and notice whether the response is curious or merely polite.
How will you keep relatives who live far away informed?
Why ask it
One named family contact is the usual arrangement, and the patient decides who is allowed to hear what. Some teams will hold a family meeting by phone or video, which spares that contact from repeating hard news five times.
Will someone tell us plainly when you think only days are left?
Why ask it
Being told in time is what lets a family call people in and say what they want to say. Ask who delivers that news and whether it comes by phone or in person, and say now if you want it without softening.
How do your visits change in the final days, and can someone be with us at the end if we want that?
Why ask it
Medicare tracks how often a hospice's patients were seen by a nurse or social worker in their last days, and the figure sits with the other scores on its comparison site. In the meeting, get the specifics: daily visits, continuous care if symptoms call for it, a volunteer to sit through part of the night.
At the time of death, who do we call, who comes, and how long will they take?
Why ask it
Knowing the sequence in advance removes one source of panic. With most hospices you phone them, not emergency services, and a nurse comes to the house. Who can pronounce the death and what happens to leftover medicines depend on state rules, so have them walk you through it for where you live.
What bereavement support continues after the death, for how long, and who is it available to?
Why ask it
Medicare requires certified hospices to offer bereavement support for about a year, but the substance varies from mailed material to counseling and support groups. It is worth knowing whether it reaches grandchildren, close friends and paid caregivers, not only the next of kin.
Meeting With a Hospice Agency
Practical guidance for the conversation itself
Before the Meeting
Mark the questions that fit your situation
No single meeting has room for the whole list. Start with the first five, then take two or three from each part that applies: Costs if the coverage is uncertain, Nights and crises if one person will be alone with the patient, Getting started if a treatment is still under way. Put the one that could rule an agency out near the top.
Bring two people if you can
One person asks the questions and the other writes down the answers. An admission visit covers a great deal, often on a difficult day, and little of it sticks without notes. If you are alone, ask whether you can record the conversation.
Have the medication list and documents ready
Bring the current medication list, insurance cards, the name and number of the primary physician, and any advance directive, living will, healthcare proxy or out-of-hospital do-not-resuscitate order. With these on the table, the agency can answer the coverage and medication questions about this patient instead of in general.
Write down what matters most to the patient
Staying at home, avoiding sedation, being alert enough to talk, having a specific person present. Say these things out loud at the interview. They belong in the plan of care, and how the team responds to them is part of what you are judging.
Comparing Two Agencies
- Get the number of scheduled nurse and aide visits per week from both, and compare the numbers, not the descriptions.
- Ask both what happens at two in the morning, and note whether a nurse can come to the house.
- Ask both how many times they provided continuous bedside care in the past month.
- Find out where each one's inpatient beds are and how far that is from home.
- Compare staff turnover over the past year and the number of patients each nurse case manager carries.
- Ask both how soon they could admit, and whether that holds on a Saturday.
- If a treatment such as transfusions or dialysis is still in the picture, ask both whether it could continue.
- If the patient lives alone or the caregiver works, ask both how they would cover the hours nobody is home.
- Look up both agencies' quality and family survey scores on Medicare's Care Compare site.
- Ask a local hospital discharge planner, nursing home nurse or your own physician which agencies they see doing good work.
After You Enroll
Keep one notebook in the house
Record each visit, who came, what changed, medication times and doses, and the phone numbers you have been given. Different family members take different shifts, and the notebook is what keeps the nurse from getting three versions of the same week.
Call earlier than feels necessary
Phone about restlessness, a change in breathing or a missed dose while it is still small. That is what the after-hours line is for, and the nurse would sooner take a short call in the evening than find a crisis at the next visit.
Ask for a care plan meeting if something is not working
If visits are too infrequent, an aide is not a good fit, or symptoms are not controlled, you can ask for the plan of care to be reviewed. If things still do not improve, families are allowed to change hospice agencies, and the social worker can explain how that works under your coverage.