Can a family switch hospice providers?

This page is for families who feel their hospice is not working and wonder if they can change. It covers what NCI says and how to switch safely.

Yes. The decision you made when you signed on can be undone.

Medicare.gov says you have the right to change your hospice provider once during each benefit period. NCI adds that once patients receive hospice care, they can always change their mind, and may revoke hospice and return to their primary insurance. So a family that finds the arrangement is not working has options.

Before you change anything, name the problem exactly. Some complaints point to a gap you can fix, not to a bad match.

NCI describes four levels of hospice care:

• Routine care, when the person is stable and symptoms are controlled, given where they live
• Continuous home care, for symptoms that are not being managed. NCI describes 8 to 24 hours of care a day.
• General inpatient care, for crisis-level symptoms that need a hospital or facility
• Respite care, temporary relief for the main caregiver (NCI says this is typically five consecutive nights every 60 to 90 days)

Say a family feels abandoned overnight during a bad symptom crisis. They may not need a different hospice at all. They may need a different level of care from the one they have. So ask a sharper question. Which level are we on, and does this situation qualify for a different one?

NCI also notes that hospice services vary by program. Two hospices can both be sound and still offer different things. So a real mismatch is possible even when nobody has done anything wrong.

A team delivers hospice care. It includes a nurse case manager, a physician, a medical director, a social worker, a chaplain, aides and volunteers. If the trouble is with one person or one part of the service, the organization can often fix it inside the team.

A social worker is part of the team and is a good person to ask for.

Say the specific thing that is going wrong. Do not just say you are unhappy. Nobody can act on a vague complaint.

Two practical points matter most.

The first is order. Line up the new provider before the old one stops. Medicare limits you to one provider change per benefit period, so ask the new hospice how a transfer works. You can also call 1-800-MEDICARE.

The second is medicines and equipment. NCI says hospice covers medicines and durable medical equipment, and what is offered varies by agency. Ask both organizations who is responsible for what during the changeover. Nothing that is keeping someone comfortable should disappear mid-move.

Use the areas NCI describes as your checklist.

• Which of the four levels of care do you provide directly, and how quickly?
• Which team members will we see, and how often?
• What happens at night and on weekends?
• What bereavement support follows? NCI's summary relays a CMS requirement: every hospice must have an organized bereavement program providing services to families for up to one year after the patient's death. The form it takes varies between programs.

Some families fear that leaving a hospice will bar them from hospice for good. NCI says patients qualify for hospice with a prognosis of six months or less. That is about the illness, not about how a family dealt with a past provider.

The summary is short. A change is allowed. The main skill is doing it in the right order.

• NCI, Hospice (PDQ)
• Medicare.gov, Hospice care