The metrics, data sources, and honest questions that separate a strong hospice from a mediocre one — most families never hear about them.
Most families in Detroit end up choosing a hospice the same way. A doctor mentions the word. A hospital discharge planner hands over a printed list. A relative says, “we used them for grandma.” Someone circles a name. That’s the decision.
It doesn’t have to be. Under federal law, families have the right to choose any Medicare-certified hospice provider — not just the one on the discharge list. And the hospices serving the Detroit tri-county area vary significantly in quality, staffing, response time, and how they actually deliver care day to day. The problem isn’t that families choose badly. It’s that no one has told them what to compare on.
What follows are the criteria that actually matter — the publicly available data, the industry benchmarks, and the specific questions that separate strong hospice care from checkbox compliance.
What the Hospital Discharge Planner Isn't Telling You
Hospital discharge planners have to give families a list of local hospice options. They usually give a short one. What families rarely realize is how that list gets built.
In most hospital systems, the list is generated from a preferred-provider roster — hospices that have contracts with the hospital, that respond quickly to referrals, that handle documentation efficiently. Those are legitimate reasons for a hospital to work with a hospice. But they’re not necessarily the same as “delivers the best care for your family.”
You don’t have to accept the first name on the list. You can ask for the full list of Medicare-certified hospices in your area. You can ask the discharge planner which hospices they think are strongest — a different question than which ones they use most. And you can research any hospice yourself using publicly available Medicare data. In many real cases, families later say the same thing: “I wish someone had told me sooner that we had a choice.”
Start With Medicare Care Compare (Here's How)
Medicare publishes quality data for every certified hospice in the country through the Care Compare tool at medicare.gov/care-compare. Almost every article about choosing a hospice mentions this tool. Almost none walk you through how to actually use it.
Here’s the practical version. When you look up a hospice on Care Compare, focus on three numbers.
Family experience scores (CAHPS). The CAHPS Hospice Survey asks family members after a patient’s death about communication with the team, symptom management, emotional and spiritual support, and overall care quality. Scores appear on Care Compare as percentages. Compare the hospice’s numbers to the Michigan average and the national average. A hospice sitting consistently below both is a signal to investigate — not to dismiss automatically, but to ask harder questions.
Quality of Patient Care measures. These clinical measures track how often specific care actions happen — timely visits, symptom assessments, treatment preferences documented. Lower percentages reflect either poor documentation habits or gaps in care delivery. Either way, worth knowing.
Live discharge rate. This one most families never look at, and it matters. A live discharge means a patient was discharged from hospice alive — often because they “no longer meet eligibility.” Some live discharge is expected, particularly in dementia care. But a hospice with a live discharge rate significantly higher than its peers may be enrolling patients who don’t fully qualify, or discharging patients before they should be discharged. Both are worth asking about.
The Four Criteria That Matter Most
Beyond Care Compare, four factors separate hospices that deliver strong care from those that just meet the federal minimum.
Accreditation beyond Medicare certification. Every hospice is Medicare-certified — it’s the price of entry. What signals higher standards is voluntary accreditation by CHAP (Community Health Accreditation Partner), ACHC (Accreditation Commission for Health Care), or The Joint Commission. Accreditation is optional. Its presence tells you the hospice is willing to be measured against a higher bar than the regulatory floor.
Nurse caseloads. The number of patients each registered nurse case manager carries is one of the clearest quality signals in hospice — and one of the hardest to get straight answers about. A caseload of 10–12 patients per nurse is standard. Caseloads of 15–20 stretch clinical attention thin. Some hospices decline to share this number. Ask directly, and note whether the answer is specific or evasive.
24/7 nursing — real or contracted. Every hospice claims 24/7 on-call nursing. What matters is what you actually reach when you call at 2 a.m. Some hospices have registered nurses answering the phone directly. Others route calls through an answering service that pages a nurse, who calls back within 15–60 minutes. Fifteen minutes is workable in a symptom crisis. An hour usually isn’t. Ask this specifically: “When I call your on-call line at 3 a.m., who answers the phone, and how quickly can a nurse actually reach my mother?”
Bereavement structure. Medicare requires 13 months of bereavement support for the family after the patient’s death. That’s the floor. Some hospices provide only the minimum — a few phone calls, some mailers. Others offer grief counseling, support groups, memorial services, and dedicated bereavement coordinators. This tells you where the hospice’s philosophy sits: are they caring only for the patient, or for the whole family?
The Ownership Question — and What the Research Says
This one doesn’t come up in most family conversations. The data is worth knowing anyway.
A 2024 study published in the Journal of the American Medical Association (JAMA) found that nonprofit hospices consistently deliver higher-rated care across the metrics families care most about — pain management, family emotional support, and communication. Related research from the RAND Corporation found that a substantially higher proportion of for-profit hospices fall into the low-performing category across CMS quality measures.
This doesn’t mean every for-profit hospice is bad. Many deliver excellent care. And some nonprofits fall short. But ownership structure is a factor worth knowing, and one you can ask about directly. The context matters, too: the hospice landscape has shifted dramatically. About 75% of U.S. hospices are now for-profit, compared to roughly 5% in 1990. The scale of that shift is exactly why quality varies so widely across providers today.
The Interdisciplinary Team Check
Federal regulations require every hospice to provide care through an interdisciplinary team. Who’s actually on the team — and how often those team members visit — tells you a lot about the quality of care.
A full team includes: a registered nurse case manager, hospice physician, certified nursing assistants (aides), medical social worker, chaplain, bereavement counselor, and trained volunteers. Some hospices also employ music therapists, massage therapists, and other specialty roles.
The question isn’t just whether these roles exist on paper — it’s whether they show up. Ask specifically: “How often does the social worker visit?” “How often does the chaplain visit?” “Is the aide the same person each visit, or does it rotate week to week?” Continuity matters, especially for patients with dementia or cognitive impairment. A new aide every visit is unsettling for them, and it’s a signal about how the hospice is staffed.
Response Time and Admission Speed
When a family calls a hospice, three response times matter, and each one tells you something different.
First-call response. How quickly can someone speak with you knowledgeably about eligibility, coverage, and next steps? Well-run hospices answer within minutes and can schedule an evaluation the same day or the next day.
Admission timeline. From the first call to the first hospice visit — how long? Most well-run hospices admit within 24 hours of the initial call. Some move faster. If you’re being told 3–5 days without a clinical reason, that’s worth questioning.
On-call response after admission. When you call the nurse line at 2 a.m., how quickly does a nurse actually respond? Fifteen minutes to a nurse callback is a reasonable benchmark. An hour is a signal something isn’t working.
Red Flags Worth Naming
A few specific signals suggest a hospice may not be the right fit for your family:
- Vague or evasive answers about staffing ratios or nurse caseloads
- No willingness to share CAHPS scores or walk you through Care Compare data
- Aggressive pressure to sign the election statement quickly
- Difficulty naming the specific team members who will be assigned to your loved one
- Unclear or shifting answers about how the on-call line actually works overnight
- No discussion of the Medicare aggregate cap or what happens if your loved one outlives the initial prognosis
- Failure to explain your right to change providers once per benefit period if you're unsatisfied
The best hospices welcome scrutiny. Hospices that deflect these questions are telling you something worth listening to.
The Eight Questions That Reveal the Most
If time is short and you can only ask a few questions, these eight tell you the most:
- What are your CAHPS family experience scores compared to the Michigan and national averages?
- What's your average nurse case manager caseload?
- When I call the on-call line at night, who answers, and how quickly does a nurse actually respond?
- How often will the aide, nurse, social worker, and chaplain visit each week — and will it be the same people?
- Are you accredited beyond Medicare certification (CHAP, ACHC, or Joint Commission)?
- What does your bereavement program actually include across the 13 months after death?
- Are you approaching your Medicare aggregate cap this fiscal year?
- If we're not satisfied, what's the process for switching to another hospice?
The answers you get will tell you more than any brochure. A hospice that answers directly is one to trust. A hospice that deflects is one to reconsider.
Talking It Through With Us
At St. Marie’s, we welcome these questions — including the harder ones. We’ll walk you through our Care Compare data, our team composition, our staffing ratios, and how our on-call line actually works at 3 a.m. And if we’re not the right fit for your family, we’ll say so — and help you find one that is.
If you’re weighing hospice for a loved one in Detroit, Southfield, Troy, Warren, Sterling Heights, or anywhere across the Michigan tri-county area, call (800) 489-7977 or reach us through our contact page. There’s no obligation, and no cost to the conversation. The right hospice for your family is out there. Finding it is worth an hour of your time.
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