Hospice Care at Assisted Living Communities: What You Need To Know

End-of-life care is a difficult topic, but it’s worth having. If you want to carry out your loved one’s wishes, you must have a heartfelt discussion about what type of care they need and how they want you to respond if they develop a life-limiting illness.

Hospice care is one of the most comprehensive end-of-life care options, as it focuses on preserving an older adult’s quality of life for as long as possible. This type of care is usually reserved for people with advanced illnesses who aren’t expected to live longer than six months. Hospice can help by providing comfort care, supporting family caregivers and easing the transition from life to death.

This guide provides an overview of the hospice services available at assisted living facilities, explains the benefits of receiving this type of care and describes the support services available to family members. You’ll also find out how much hospice care costs and learn about some of the most common funding options.

What Is Hospice Care?

Hospice care is a type of medical care given to people with life-limiting illnesses that can’t be cured. Nurses, doctors, therapists and other medical professionals work as a team, paying close attention to each patient’s physical and psychological needs. Hospice providers also have ministers, rabbis, social workers, bereavement specialists and other staff members available to meet the spiritual and psychosocial needs of patients and their family members. A hospice provider may offer the following:

• Symptom management
• Physical therapy
• Nutrition counseling
• Respite care for family members
• Grief counseling
• Medical equipment
• Inpatient care

Hospice care is available in multiple settings, including assisted living communities, hospitals, dedicated hospice facilities and in seniors’ homes. As of 2023, all but four states allow assisted living facilities to offer hospice services. If you live in Idaho, Mississippi, Montana or North Dakota, you’ll need to choose another setting for your loved one.

Is Hospice Care the Same Thing as Palliative Care?

Hospice care and palliative care have some similarities, but they aren’t the same thing. When someone enters hospice, the focus is on making them comfortable. Hospice care isn’t used to cure any illnesses. In contrast, people in palliative care may receive curative care in addition to comfort care. Additionally, hospice providers typically offer more services to help patients and caregivers through the grieving process.

Use the table below to compare hospice care with palliative care.

What Hospice Care Services Are Offered in Assisted Living Communities?

Assisted living communities offer many of the same services as hospitals, standalone hospice centers and other facilities. As with any type of medical care, the services available depend on which community you choose. However, your loved one may receive the following:

• Aide assistance
• Medication management
• Housekeeping and laundry services
• Grief counseling
• Memory care to help with dementia
• Nutrition counseling or meal planning
• Emotional support

What Are the Benefits of Receiving Hospice Care in an Assisted Living Community?

Receiving hospice care in an assisted living community has many benefits. Some of these benefits relate to the availability of trained staff members, while others are associated with the residential setting. These are some of the top benefits of getting hospice services in an assisted living facility.

• Companionship: If your loved one moves to an assisted living community, they’ll be able to socialize with other residents, which may help them keep their spirits up during a difficult transition.
• Memory care: Many assisted living communities offer memory care services for residents with dementia and other types of cognitive decline. These services keep residents safe and help them retain as much cognitive function as possible.
• Residential environment: Moving to assisted living allows older adults to receive hospice care in a residential setting instead of a clinical one, putting them more at ease.
• Strong family support: If your loved one receives hospice care at an ALF, you’ll have access to support groups and other resources to help you manage your grief and understand what’s happening at every stage of the process.
• Spiritual care: Many assisted living communities have chaplains available to answer some of the tough questions likely to arise once your loved one enters hospice. Spiritual care helps patients and their family members accept that death is a natural part of life.

What Support Services Are Provided for Families of Those in Hospice Care?

What makes hospice so different from other types of medical care is that staff members strive to support each patient’s loved ones and help them through the grieving process. Here are some of the services you can expect to receive as the family member of someone receiving hospice care:

• End-of-life planning assistance
• Grief counseling
• Support groups
• Care coordination
• Visits with the chaplain

How Much Does Hospice Care Cost?

The cost of hospice care depends on many factors, such as which setting you choose and what type of insurance your loved one has. However, the Centers for Medicare & Medicaid Services caps the annual amount paid for inpatient hospice care. For 2023, the cap is $32,486.92.

Remember that hospice is intended for adults who aren’t expected to live for more than six months. Many people live longer, however, so you may want to plan on paying for over one year of care just to be safe.

Does Medicare Cover Hospice Care?

Medicare covers hospice care if your loved one meets the eligibility requirements. If they’re approved, they’ll pay nothing out of pocket for hospice services. However, there’s a $5 copay for prescriptions used to manage pain and other symptoms, along with a 5% coinsurance charge for inpatient respite care. If your loved one moves to assisted living, they may also have to pay for their own room and board, as Medicare doesn’t usually cover these expenses.

Requirements for Medicare Coverage of Hospice Care

To use Medicare to cover the cost of hospice care, your loved one must meet the following criteria:

• They have Medicare Part A.
• They want to receive comfort care (palliative care) instead of care intended to cure their illness.
• Their primary care doctor and their hospice physician verify that they’re expected to live for no more than 6 months.
• They must sign a statement indicating that they want to receive hospice care instead of other treatments.

Is There Other Financial Assistance Available for Hospice Care?

If your loved one doesn’t meet the Medicare hospice coverage requirements, they may be able to use Medicaid, veterans benefits or private insurance to cover some or all of the costs.

Medicaid

The Centers for Medicare & Medicaid Services have a list of mandatory services that all state Medicaid programs must cover. Hospice care isn’t on that list, but the good news is that most states offer some type of Medicaid coverage for hospice services.

The amount of coverage available depends on the terms of your state Medicaid plan. For example, beneficiaries in Alaska need to get prior authorization for hospice care, while Missouri Medicaid has daily quantity limits on some services. Connecticut is the only state that doesn’t cover hospice care for beneficiaries over the age of 19. Oklahoma Medicaid also has severe restrictions, as hospice care is only available under the ADvantage Waiver program, which covers a variety of services for older adults and adults with disabilities.

To qualify for hospice care under a state Medicaid program, your loved one must meet all Medicaid eligibility requirements related to residency, citizenship, income and assets. Medicaid is a need-based program, so your loved one may not qualify if they have significant financial resources.

In most states, Medicaid doesn’t have any copays or coinsurance requirements for this type of care. The most notable exception is Florida, which requires beneficiaries to pay a patient share based on their incomes.

Veterans Benefits

The Department of Veterans Affairs includes hospice care in its standard benefits package. If your loved one has VA benefits and meets the coverage requirements, they’ll have no out-of-pocket costs. To use VA benefits to pay for hospice care, your loved one must meet the following criteria:

• Presence of a life-limiting condition
• Life expectancy of 6 months or less
• Seeking comfort care instead of curative care

Private Insurance

Many private health insurance plans cover some type of hospice care, but the amount of coverage available depends on which plan your loved one has. Some plans have no cost-sharing requirements for hospice services, while others may require the member to meet a deductible, pay a flat fee (copay) for each covered service or meet certain coinsurance requirements.

The same rules apply to long-term care policies. Long-term care insurance reimburses policyholders for some of their covered expenses, up to a daily limit for each service. In most states, long-term care policies are sold by private insurance companies, so they get to dictate what’s covered and how much it costs. Many plans cover hospice services, but some don’t, so check your loved one’s policy documents carefully.

Questions to Ask When Choosing a Hospice Care Provider

Choosing the right hospice care provider is a difficult process, but it’s well worth the effort. You need to feel comfortable with your decision, so use the checklist below to find a provider that’s capable of providing high-quality physical, emotional and spiritual care.

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Resources for Loved Ones of Seniors in Hospice Care

Caring for a loved one with a life-limiting illness can be overwhelming. The organizations below offer in-depth resources to help caregivers make wise decisions without burning themselves out.