People with dementia (PWD) make up more than half of the 1.7 million Medicare beneficiaries who receive hospice care each year and represent the fastest-growing group of hospice enrollees. Yet when the Medicare Hospice Benefit began in 1983, it was designed for people dying of cancer. Unlike cancer patients, PWD often experience long and unpredictable trajectories of decline. This huge shift has placed PWD at the center of policy debates about how to incentivize high-quality hospice care across all diseases and settings. Qualitative research shows that caregivers of PWD want and need additional support from hospice, particularly aide support for toileting and bathing help. Yet there are currently no requirements or even guidelines for hospice visit patterns, including how often visits should occur or what type of staff hospices should send on visits. PWD are considered the primary drivers of Medicare’s $23.7 billion in hospice expenditures due to their long hospice enrollment. Hospices receive Medicare payments for each day a patient is enrolled, regardless of whether hospice staff visit the patient. Given the unique vulnerabilities of PWD and their families, the per diem payment structure puts them at risk of being enrolled and then not provided services. In the words of the Office of the Inspector General: “the current [hospice] payment system creates incentives for hospices to minimize services…”. This concern is magnified now that 77% of hospices are for-profit and dominate the care of PWD. For-profit hospices provide a narrower range of services, employ less skilled staff, and spend less on direct patient care such as home visits. PWD who disproportionately enroll in for-profit hospices and those with lower quality ratings, are at even higher risk of not receiving care. We do not know how visit patterns vary across types of hospice agencies nor what hospice visit patterns for PWD look like at agencies with high- versus low-quality ratings. In response to concer