For assisted living communities and RCFEs

Can a resident stay in an RCFE on hospice?

Yes, when the conditions in Health and Safety Code 1569.73 and Title 22, section 87633 are met. We care for people wherever they call home, including nursing facilities, RCFEs and board-and-care homes, in coordination with facility staff. The law lets a terminally ill resident remain in a familiar place rather than move at the end of life, as long as the facility can meet the resident's needs with hospice support and the arrangement does not put other residents at risk.

What the facility must have in place

In general terms, the statute and regulations look for the following. Read the current text for the exact requirements.

• A hospice care waiver from the Department of Social services licensing agency. The facility requests it under Title 22, section 87632, and the request states the maximum number of terminally ill residents the facility will care for at one time.
• A hospice that is licensed by the state and certified by Medicare, chosen by the resident or the resident's representative.
• A written request from the resident or representative to stay in the facility and receive hospice there.
• A written hospice care plan, agreed by the facility and the hospice before hospice services begin, and kept in the resident's record.
• Facility staff trained for the tasks the hospice care plan assigns to them.
• Continued compliance with all other licensing rules. Keeping the resident must not threaten the health and safety of other residents or violate their personal rights.

What goes into the hospice care plan

The hospice care plan is the working agreement between your facility and the hospice for one resident. It names the hospice and the facility and says which tasks each will carry out. It lists the hospice team members, their visit patterns and how to reach the hospice at any hour. It describes the resident's care needs, the medicines and who handles them, the equipment, and any training facility staff need for this resident. It is updated when the resident's condition changes. The hospice remains responsible for the professional management of hospice care. The facility remains responsible for the care and supervision it is licensed to provide.

Who does what

The resident's own hospice care plan controls. This table is a general illustration.

Medications and bedbound residents

RCFE staff who are not licensed health professionals assist residents with self-administered medicines. They do not administer injections or make dosing judgments. The hospice care plan should say exactly which comfort medicines are in the facility, how they are stored, who may give what, and when to call the hospice nurse instead. When a resident can no longer take medicines by mouth, call the hospice so the nurse can change the route or regimen.

Many hospice residents become bedridden as defined in licensing law. RCFE rules allow a facility to keep a bedridden resident on hospice, with conditions that include notifying the local fire authority within the time the regulations set. Check Health and Safety Code 1569.72 and Title 22 for the current steps. We will tell you promptly when our assessment shows a resident has become bedbound so you can meet your notice duties.

Change of condition and incident communication

Good coordination is mostly fast, two-way reporting.

• Call the hospice at any hour for new or worse pain, shortness of breath, agitation, a fall, a medication error, refusal of food or fluids, or signs that death is near.
• We tell the facility after each visit what changed: new orders, medication changes, equipment on the way, and what to watch for. We adapt to the facility's requested practice: we identify the facility contact, give a concise visit update through the agreed channel, record it in the resident's record and escalate urgent changes promptly.
• Care plan updates are shared with the facility when the hospice plan of care changes.
• Licensing reports. Incidents and deaths that the facility must report to Community Care Licensing remain the facility's duty. We provide the clinical information you need for the report.
• 911 and hospital transfers. A resident on hospice can still go to the hospital. When possible, call the hospice first so a nurse can assess and the resident's wishes and POLST are followed.

Staff education, open to all

We offer education on hospice topics such as recognizing end-of-life changes, comfort care basics, and how the hospice care waiver works. Sessions are educational, open to any facility or caregiver in the community, and are not tied to whether a facility has ever referred a resident to us. Topics can include hospice referral and admission coordination, comfort-focused care, recognizing and reporting changes, communicating with families and coordinating facility visits, offered as focused sessions at times agreed with the facility.

How to start

If a resident is declining, the resident's physician, the family or facility staff can call us with the family's agreement. We will arrange an informational visit with the resident and family. Families can read hospice in assisted living. To make a referral, use Refer a patient.

Common questions