OHD Learn · Provider Type Guide

Hospice Care

Care focused on comfort, dignity, and support — for patients and the families who love them — when curative treatment is no longer the path forward.

What Is This Type of Care

Support and peace at the end of life.

Hospice is specialized care for those who have reached a point where treatment is no longer an option. The purpose shifts to managing symptoms, easing pain, and supporting the emotional weight it places on everyone it touches.

Care is provided wherever the patient calls home, most often in a private residence, but also in assisted living facilities, nursing homes, and dedicated inpatient hospice facilities. A hospice team typically includes nurses, physicians, social workers, chaplains, home health aides, and volunteers. Together they support not just the patient, but the family: helping caregivers understand what to expect, how to help, and how to cope.

The measures CMS collects are not about clinical outcomes. They are about whether the hospice provided compassionate, competent care during one of the most difficult periods a family can face.

What the Data Covers

Two sources of evidence, from the agency and from the family.

Hospice quality data comes from two distinct sources, and it is worth understanding which is which. The first is information submitted directly by hospice agencies as part of federally required clinical assessment. The second is a survey of family members and caregivers, completed after their loved one has died, reflecting how they experienced the care their family received.

Agency-Submitted Quality Measures
Reported through the Hospice Item Set (HIS), a standardized clinical assessment completed by the hospice agency at admission and discharge. These measures track whether required care processes were carried out.
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Goals of Care and Comfort Preferences
At the heart of hospice is the belief that patients should have a voice in how they are cared for at the end of life. Two measures track whether this happened: whether treatment preferences were documented, and whether the patient's personal beliefs and values were explored and addressed, if that was something the patient wanted.
  • Treatment preferences documented at admission
  • Beliefs and values addressed, if desired by the patient
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Symptom Management
Controlling pain and difficulty breathing are among the most fundamental obligations of a hospice. Four measures track whether patients were screened for pain and breathlessness on admission, whether those who were found to have symptoms received a full clinical assessment, and whether patients on opioids received a bowel regimen, a common and important preventive measure for patients on those medications.
  • Pain screening at admission
  • Pain assessment when screening indicates a problem
  • Dyspnea (breathlessness) screening at admission
  • Dyspnea treatment when screening indicates a problem
  • Bowel regimen for patients treated with an opioid
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Comprehensive Assessment at Admission
A composite process measure that combines the seven individual Hospice Item Set measures into a single score. It reflects what share of patients received a complete, thorough assessment across all required clinical domains at the start of their hospice care, a foundational step that shapes everything that follows.
  • Composite of all seven HIS process measures
  • Reported as the percentage of patients receiving all required assessments
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Visits in the Final Days of Life
One of the most closely watched hospice measures: what share of patients received a visit from a registered nurse or medical social worker on at least two of the final three days of their life. The final days are often the most physically and emotionally intense for a patient and family. This measure asks whether the hospice was there.
  • Percentage of patients visited by an RN or social worker in the last 3 days
  • Based on 24 months of data; refreshed annually
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Hospice Care Index
A composite score from 0 to 10 that summarizes a hospice's performance across ten distinct clinical and operational indicators. Unlike the process measures above, the Hospice Care Index is built entirely from Medicare claims, with no agency submission required. It captures patterns in how a hospice actually delivered care over a two-year period: who received visits, how often nursing gaps occurred, how patients were discharged, and what Medicare spent.
  • Overall score (0–10)
  • Continuous home care and general inpatient care provided
  • Gaps in skilled nursing visits
  • Early and late live discharges
  • Burdensome transitions (two types)
  • Per-patient Medicare spending
  • Skilled nursing minutes per routine home care day
  • Skilled nursing on weekends
  • Visits near death
Family Caregiver Survey (CAHPS Hospice Survey)
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey is completed by family members and caregivers after the patient has died. Because the patient is often unable to respond, this survey is the primary source of experience-based evidence in hospice, a reflection on care received during a deeply personal time.
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Communication and Timeliness
Families are asked how well the hospice team communicated, whether they felt informed, whether their questions were answered, and whether help arrived when it was needed. Two separate measures capture team communication and the timeliness of care, rated on a three-point scale from "always" to "sometimes or never."
  • Hospice team communicated well
  • Hospice team provided timely help
  • Reported as top-box, middle-box, and bottom-box percentages
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Dignity, Respect, and Emotional Support
Two of the survey's most personal measures: whether the hospice team always treated the patient with respect, and whether families felt the team provided the right amount of emotional and spiritual support. These questions touch on what it means to be cared for, not just clinically, but as a human being.
  • Patient always treated with respect
  • Right amount of emotional and spiritual support provided
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Symptom Help and Caregiver Training
Family members reflect on whether the patient always got the help they needed for pain and other symptoms, and whether the hospice gave them the training they needed to care for their loved one at home. These are practical questions, but they carry deep weight for caregivers who are managing complex care with little clinical background.
  • Patient always got needed help for pain and symptoms
  • Family received the training they needed to provide care
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Overall Rating and Recommendation
Families rate the hospice agency as a whole on a 0–10 scale, and answer whether they would recommend it to someone else. A summary star rating (1 to 5 stars) combines all eight survey measures into a single score. This rating is updated twice a year and reflects up to 24 months of caregiver responses.
  • Overall agency rating (0–10)
  • Would recommend this hospice to others
  • Summary star rating (1–5 stars), updated twice yearly
About the Data

Where the data comes from and how often it is updated.

Hospice quality data is published by the Centers for Medicare and Medicaid Services as part of the Hospice Quality Reporting Program. Coverage is broad, with over 5,000 hospice agencies included, and participation in quality reporting is required for Medicare-certified providers.

Most measures are updated quarterly. The Visits in the Last Days of Life measure and the Hospice Care Index are each based on 24 months of data and refreshed annually, because smaller hospice agencies serve fewer patients and a longer collection window produces more stable results. CAHPS caregiver survey scores are updated quarterly; the summary star rating is updated twice a year.

Some scores are suppressed when the number of patients or survey responses is too small to report reliably, a protection both for patient privacy and for the integrity of the data.

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A note on the family caregiver survey. CAHPS Hospice Survey responses are collected from family members during the period after the patient's death. CMS requires a minimum number of completed surveys before a score is publicly reported, and agencies that are too new, too small, or that did not meet submission requirements may show a footnote in place of a score.
Sources
  1. CMS Hospice Center — cms.gov
  2. CMS Data Dictionary for Hospice Quality Reporting Program Data on Care Compare, Version 14.2, May 2025 — CMS Provider Data Catalog