The RCFE hospice care waiver in California

What does the hospice care waiver allow?

It lets the facility retain a terminally ill resident, or accept one, and allow a licensed, Medicare-certified hospice to provide hospice care in the facility, including for a resident who becomes bedridden, which the licence would otherwise not permit. The facility keeps its non-medical role, room, board, supervision and the care in the hospice care plan that is assigned to it, and the hospice provides the clinical care, the medicines, the equipment and a nurse by phone 24 hours a day. The waiver states the maximum number of hospice residents at one time, and the facility may not exceed it.

What must the facility have in place?

Section 87633 and Health and Safety Code 1569.73 set the conditions. In general terms, before hospice services begin for a resident:

• The hospice care waiver, requested under section 87632 and approved for the number of residents the facility will serve.
• A hospice licensed by the state and certified by Medicare, chosen by the resident or the resident's representative, not by the facility.
• A written request from the resident or representative to remain in, or be admitted to, the facility and receive hospice care there.
• A written hospice care plan agreed between the facility and the hospice, kept in the resident's record, that says who does what: the hospice's services, the facility staff's tasks, the medicines and who administers or assists with them, and how changes are communicated.
• Facility staff trained for the tasks the plan assigns to them, with the training documented.
• Continued compliance with every other licensing requirement. Keeping the resident must not threaten the health and safety of other residents or violate their personal rights.

Bedridden residents and fire clearance

A hospice resident often becomes bedridden. The licence allows a bedridden resident only with the appropriate fire clearance for the building, so the facility should confirm its clearance covers bedridden residents, and in what number, before the need arises. Health and Safety Code 1569.72 governs bedridden residents; the regional licensing office can tell you whether your clearance is adequate. A facility that waits until a resident is already bedridden has no time to fix it.

The exception route

For a single resident, where the facility does not hold a waiver, or the resident's needs fall under a restricted condition, the licensee can request an exception from the regional office under the general exception provision of Title 22. The exception is specific to the resident and the circumstances, and the same written request, hospice choice and care plan are expected. It is slower than a standing waiver and is not a substitute for one in a facility that regularly serves hospice residents.

How do you apply?

The licensee submits a written waiver request to the Community Care Licensing regional office that oversees the facility, stating the maximum number of terminally ill residents the facility will care for at one time and how the facility will meet section 87633: staffing and training, the hospice agreement, the fire clearance and the care-planning process. The regional office may ask for a plan of operation update. Keep the approval letter in the facility file; surveyors ask for it. Your licensing analyst is the person to ask which form and attachments the office currently expects.

What Beta provides the facility

A written hospice care plan for each resident before services begin, with the facility's tasks spelled out; staff education on the plan, the comfort medicines and when to call; a nurse by phone 24 hours a day; the equipment and supplies; and one point of contact for the administrator. We serve residents in RCFEs across the Inland Empire and work with the facility's own policies. Read assisted living and RCFE and the family page hospice in assisted living.

Common questions about the hospice care waiver