Hospice and the Assisted Living Waiver: can you have both?

How the two work together in an assisted living home

Hospice is comfort-focused medical care for people with a serious illness when a doctor certifies a life expectancy of six months or less if the illness runs its usual course. The hospice brings a nurse, doctor, aide, social worker and chaplain, and it is paid by Medicare, Medi-Cal or private insurance. The Assisted Living Waiver is a Medi-Cal program that pays a participating assisted living home for care services, at rates set by the Department of Health Care Services (DHCS), for adults who need a nursing-facility level of care.

Neither program pays room and board. The resident pays the bed and meals from their own income, with or without hospice and with or without the waiver.

The names are confusing. A hospice care waiver is a state permission that lets a licensed assisted living home keep a resident who is on hospice. The Assisted Living Waiver is the Medi-Cal program. A home needs the first to keep a resident on hospice, whether or not the resident is on the second.

What changes when hospice starts for an ALW resident

The home keeps its ALW role and its licensed responsibilities, and must hold a hospice care waiver from the state. The hospice leads the plan of care for the terminal illness and adds its nursing visits, aide visits, medicines and equipment for that illness. The waiver's care coordination agency (CCA) stays the ALW contact and keeps its own assessments and service plan. Electing hospice does not end waiver care coordination.

It is not automatic. The three need to agree, for this person, who supplies which medicines and equipment and who is called first when something changes. Being on hospice does not make someone eligible for the waiver, and being on the waiver does not make someone eligible for hospice; each program has its own rules and its own review.

You can choose any hospice and any waiver care coordination agency. Using Beta for one never affects your access to the other, and Beta's teams do not steer that choice. No facility or agency may make waiver services or placement depend on choosing a particular hospice.

How to start

For hospice, call Beta Hospice or ask a nurse to call you back. The hospice team coordinates with the home and the CCA when a resident is on the waiver. Families can read hospice in assisted living and paying for care; facility staff can read hospice for assisted living and RCFE residents.

For the waiver, start on alwbeta.com (opens in a new tab). There is no state website for ALW applications; Beta's ALW team takes the whole application online, or by phone at (747) 293-5777. The hospice team at this website cannot take waiver requests.

Beta's ALW program, on alwbeta.com

Beta's ALW team runs the waiver program on its own website. These pages answer the questions people bring here.

• Assisted Living Waiver program overview (opens in a new tab), what the waiver is and how Beta's care coordination works
• Who qualifies for the Assisted Living Waiver (opens in a new tab), the things that have to be true before anyone applies
• How the application works, step by step (opens in a new tab), from the waitlist request to DHCS approval
• Apply for the Assisted Living Waiver (opens in a new tab), the online application
• What the waiver pays and what residents pay (opens in a new tab), including room and board
• The ALW waitlist (opens in a new tab), how it works and who gets priority
• Care coordination agencies (opens in a new tab), what a CCA does and how to change agencies
• Participating assisted living homes (opens in a new tab), every home on the state's list, by county and city
• Assisted Living Waiver in Orange County (opens in a new tab)
• Assisted Living Waiver in San Bernardino County (opens in a new tab)