Your mother does not have to move to receive hospice. If she lives in an assisted living community, a memory care unit or a nursing home, hospice comes to her room. The facility keeps doing what it already does, and the hospice team layers a second set of services on top: nursing visits, aide care, medications and equipment for her illness, social work, chaplain support, and a nurse on the phone 24 hours a day. Medicare pays the hospice directly. What Medicare does not pay is her room and board at the facility. That part stays the same as it is today.

Here is how the pieces fit together.

Two teams, one plan of care

The simplest way to picture it: the facility is your mother’s home, and hospice is the specialist team that visits her at home.

What the facility continues to do

  • Daily help with meals, dressing, toileting and mobility, according to her care level
  • Housekeeping, laundry, activities and social life
  • Medication administration by facility staff, where the facility does that
  • Routine nursing, if it is a skilled nursing facility
  • Calling the family and the hospice when something changes

What hospice adds

  • A hospice nurse who visits on a regular schedule, manages symptoms, adjusts the plan of care with the hospice physician, and is reachable by phone around the clock
  • A hospice aide for extra hands-on comfort care, such as bathing, skin care, and repositioning, coordinated with facility aides so nothing is duplicated and nothing is missed
  • A social worker to help with paperwork, family meetings, advance directives and the emotional side of caregiving
  • A chaplain for spiritual support in whatever form your family wants, or none
  • Volunteers for companionship, reading, music or simply sitting with her
  • Medications, equipment and supplies related to the terminal illness, such as pain and breathing medicines, a hospital bed, a pressure-relieving mattress, oxygen, a wheelchair, incontinence supplies and wound care supplies
  • Bereavement support for the family for up to a year after a death

Both teams work from a single, written plan of care that the hospice develops with the facility, your mother and your family. It spells out who does what.

Who to call when something happens

This is the question families ask most, so keep it simple:

  • For daily needs (she needs help to the bathroom, she wants a snack, the TV remote is missing): facility staff, as always.
  • For symptoms (new pain, trouble breathing, restlessness, a fall, a change in alertness): the hospice nurse line. The facility will usually call hospice themselves, but you can also call directly.
  • For emergencies where she has chosen comfort care: the hospice first. Part of the plan of care is deciding in advance what to do about hospital transfers, so nobody has to make that call in a panic.

The hospice nurse and the facility nurse communicate regularly, and the hospice documents every visit in a way the facility can see.

What Medicare pays, and what it does not

The Medicare hospice benefit pays the hospice for the services listed above. Your mother’s costs for hospice itself are minimal: she may owe up to $5 per prescription for outpatient pain and symptom medications, and 5% of the Medicare-approved amount for inpatient respite care. Routine hospice visits carry no copay.

Medicare hospice does not pay for room and board in an assisted living community or a nursing home. That rent or daily rate continues to be paid however it is paid today, whether that is private funds, long-term care insurance, or a Medicaid program.

In a nursing facility, Medicaid may cover room and board

If your father lives in a nursing home and qualifies for Michigan Medicaid, Medicaid can pay the nursing facility’s room and board while Medicare pays the hospice. The two programs are designed to work together. The hospice social worker and the facility’s business office can help you understand how this applies to his situation.

What about the “skilled” Medicare nursing home benefit?

This trips up a lot of families. Medicare Part A pays for a limited stay in a skilled nursing facility after a qualifying hospital stay, when a person needs daily skilled care such as rehabilitation. That is a different benefit from hospice, with different rules, and Medicare will not pay the nursing home’s room and board under the hospice benefit. If your father is currently in a facility under the skilled benefit, ask the hospice social worker to walk through what changes when hospice is elected. You deserve a clear answer before you sign anything.

Assisted living versus memory care versus nursing home

The hospice services are the same in all three settings. What differs is how much the facility itself provides.

  • Assisted living typically offers help with daily activities but limited nursing. Hospice fills the medical gap, and the aide visits are often especially valuable.
  • Memory care adds secured units and staff trained in dementia. The hospice team focuses on comfort, pain that a person cannot describe, swallowing and nutrition, and helping staff read behavior as communication.
  • Nursing homes already have nurses on site. Here, hospice brings symptom expertise, more frequent eyes on the patient, and support for the family and the facility staff who have often known the resident for years.

The family’s role

You are not a bystander. In a facility setting, families sometimes feel like the professionals have it handled and step back. Please don’t.

  • Be the historian. You know what your mother’s normal looks like and what she would want. Say so.
  • Be present at the admission visit if you can. That is where the plan of care is built.
  • Ask for the plan in writing and ask who the primary hospice nurse is.
  • Tell hospice about the facility’s rhythms. Shift changes, meal times, which aide she likes best.
  • Use the support that is for you. The social worker, the chaplain and bereavement counselors are for the family too.

Many facilities have residents on service with several different hospices at once. You have the right to choose which hospice cares for your mother. The facility can offer names, but the choice is yours.

How Lily handles this

Lily Hospice serves patients wherever they live across Oakland, Macomb and Wayne counties, including assisted living, memory care and nursing facilities. When a patient is admitted in a facility, we build the plan of care with facility staff and your family together, coordinate aide schedules with the facility so care is layered rather than duplicated, and provide our 24/7 nurse line to both the facility and the family. Our Journey Program can bring virtual reality experiences to a resident’s room, and our respite services remain available if a family caregiver is still doing a great deal of the day-to-day care.

Frequently asked questions

Will hospice make my mom move out of assisted living? No. Hospice comes to her. In most cases the facility is glad to have the added support. If her needs ever exceed what the facility can provide, the hospice social worker will help you think through options.

Does Medicare hospice pay for the nursing home? No. Medicare pays the hospice for hospice services. Room and board at the facility is paid the way it is paid now: private funds, long-term care insurance, or Medicaid in a nursing facility if she qualifies.

Who gives her medications, hospice or the facility? Hospice supplies and pays for medications related to the terminal illness. Facility staff usually administer them, following the hospice plan of care. This is spelled out at admission.

Can we still choose our own hospice if the facility recommends one? Yes. The choice of hospice belongs to the patient and family, not the facility.

Does the hospice aide replace the facility’s aides? No. The hospice aide adds visits focused on comfort care and is scheduled around what facility staff already do.

Talk to us

If your parent lives in a facility and you are wondering whether hospice can help, call Lily Hospice at (248) 955-5100. A real person answers 24 hours a day. We can talk with you and with the facility, explain what changes and what does not, and arrange an admission visit in your parent’s own room.

Written and reviewed by the Lily Hospice clinical team.

Sources

  • Medicare.gov, “Hospice care”: https://www.medicare.gov/coverage/hospice-care
  • Medicare.gov, “Medicare Hospice Benefits” (official booklet, PDF): https://www.medicare.gov/publications/02154-medicare-hospice-benefits.pdf
  • CMS, Medicare Benefit Policy Manual, Chapter 9, “Coverage of Hospice Services”: https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/bp102c09.pdf
  • National Alliance for Care at Home (formerly NHPCO), Hospice Care Overview: https://www.nhpco.org/hospice-care-overview/