Hospice CAHPS Survey Scores and Star Ratings Explained
What the family caregiver survey measures, who answers it, how the star rating is set, and why some hospices show no scores.
What the CAHPS Hospice Survey is
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey is a national survey that asks families about their experience with a hospice. CMS says it was developed partly to give families publicly reported information they can use when selecting a hospice (CAHPS Hospice Survey). National implementation began January 1, 2015. Hospices must contract with a CMS-approved survey vendor, and hospices serving 50 or more survey-eligible patients a year must take part to receive their full Medicare annual payment update (CMS: CAHPS Hospice Survey).
Who answers it
The survey goes to the primary informal caregiver of a patient who died while receiving hospice care, usually a spouse, adult child, other relative, or friend who knew the most about the care. Survey administration begins two months after the month of the patient's death, and it is conducted by mail, phone, a mix of mail and phone, or web with mail follow-up. It is available in several languages, including English and Spanish (About the survey).
Because the survey reflects the family's view after the patient's death, it captures what families experienced directly: whether calls were returned, whether staff explained things clearly, and whether the family felt supported. It does not capture the patient's own words.
The measures you will see
CMS lists these CAHPS Hospice Survey measures (CMS: HQRP current measures):
- Communication with family: whether the team kept the family informed, explained things clearly, listened, and let them know when they would arrive.
- Getting timely help: whether help came as soon as needed, including evenings, weekends, and holidays.
- Treating the patient with respect: dignity, respect, and whether staff really cared about the patient.
- Emotional and spiritual support: support for the family during hospice care and after the death, and for religious, spiritual, or cultural beliefs.
- Help for pain and symptoms: pain, trouble breathing, constipation, and anxiety or sadness.
- Training family to care for the patient: whether the team taught the family how to help with medicines, breathing problems, restlessness, and other needs.
- Rating of this hospice: the family's overall rating on a 0 to 10 scale.
- Willing to recommend this hospice: whether the family would recommend it to friends and family.
Scores are generally "top-box" percentages: the share of families who gave the most favorable answer, such as "always," or a 9 or 10 rating. They are adjusted for differences in the patients served and in how the survey was taken, so hospices can be compared more fairly (CAHPS Hospice Survey Star Ratings).
A revised survey in 2025
A shorter, revised version of the survey began with patients who died in April 2025 (the second quarter of 2025). It added a new Care Preferences measure, which asks whether the team provided care that respected the patient's wishes and listened to what mattered most. It also substantially revised the family training measure and slightly revised the communication measure (CAHPS Hospice Survey Star Ratings).
Because Care Compare scores use eight rolling quarters of data, the change is phased in. According to the survey's official star rating FAQ, from the May 2026 Care Compare refresh through November 2027, scores combine quarters from the original and revised surveys. During this transition, scores and star ratings for Care Preferences and the revised training measure are not reported, and the summary star rating is based on the seven other measures. CMS expects the February 2028 refresh to be the first to use eight quarters of revised-survey data.
How the star rating works
Care Compare shows a single summary star rating called the Family Caregiver Survey Rating, on a scale of one to five stars (Medicare.gov: Family caregiver survey rating). CMS calculates a star rating for each survey measure and combines them into this weighted summary; only the summary is shown publicly. Star ratings were first published in August 2022 and are updated every other quarter, or about every six months. Stars are assigned by grouping hospices with similar scores, so the cut-off between star levels can shift from one update to the next, and CMS does not force a set number of hospices into any star level (CAHPS Hospice Survey Star Ratings).
Why some hospices have no scores
A blank space on a hospice's page usually reflects sample size, not quality:
- Individual measure scores are shown only for hospices with at least 30 completed surveys over the reporting period (CAHPS public reporting).
- A star rating requires at least 75 completed surveys over the eight-quarter period, because fewer responses are not reliable enough to distinguish between hospices.
- Hospices that served fewer than 50 survey-eligible patients in a year may request an exemption from the survey, and must reapply each year (CMS: CAHPS Hospice Survey).
- Newer hospices may not yet have enough data.
Using the scores well
Survey scores are among the most useful information available, because they come from families who went through the same experience you are facing. Still, they describe the past, not a guarantee. Look at the measures that matter most to you, such as getting timely help at night if you are caring for someone at home. Compare hospices that serve your area, and ask about any low score directly; a good hospice should be willing to explain what it is doing to improve.
This guide is general information, not medical or legal advice.