Resources for families
Hospice care in assisted living facilities in California
Yes. A person living in a California assisted living community or board and care home can receive hospice there, as long as the facility holds a hospice care waiver from its state licensing agency and agrees it can meet the person's needs. The hospice team visits the resident in their room. The facility keeps providing daily care, meals and supervision. The resident keeps paying the facility for room and board.
Medically reviewed by Oscar Chien, MD, Medical Director, September 24, 2026
On this page (9 sections)
- What is an RCFE in California?
- What is the RCFE hospice care waiver?
- Who does what when an assisted living resident is on hospice?
- Who pays for hospice in assisted living?
- Can you have hospice in a memory care community?
- Is hospice the same as memory care?
- What should you ask an assisted living facility about hospice?
- Common questions about hospice in assisted living
- For facility administrators and staff
What is an RCFE in California?
In California, assisted living communities, memory care communities and small board and care homes are all licensed as a residential care facility for the elderly, or RCFE. The license comes from the California Department of Social Services, Community Care Licensing Division. An RCFE is a non-medical home. It is different from a skilled nursing facility, which is a medical facility licensed by the Department of Public Health.
Because an RCFE is non-medical, the law sets limits on the health conditions it may care for. Hospice is one of the ways a resident with a terminal illness is allowed to stay.
What is the RCFE hospice care waiver?
The hospice care waiver is a permission the state gives to an RCFE so it can keep or accept a resident with a terminal illness who is receiving hospice. Under Health and Safety Code section 1569.73 and state regulations (California Code of Regulations, title 22, section 87633), an RCFE may keep a terminally ill resident who is receiving hospice, or accept one, when the facility has a hospice care waiver from the Department of Social Services. With the waiver in place, a resident on hospice can remain in the facility even when their needs go beyond what an RCFE may normally handle, such as being bedbound.
The rules also expect that the resident has chosen a licensed hospice, that the hospice and the facility agree on a written plan that says who does what, and that the facility can still meet the person's needs with the hospice's support. The waiver allows the facility to keep a resident. It does not force it to. Ask early, before a crisis.
Who does what when an assisted living resident is on hospice?
When an assisted living resident is on hospice, the facility keeps providing room, meals, daily personal care and supervision. The hospice team adds nurse visits, hospice aide visits, medicines, equipment and supplies related to the terminal illness, a nurse by phone day and night, and support for the family.
| The facility | The hospice team |
|---|---|
| Room, meals, housekeeping and laundry | Nurse visits to assess and manage pain and other symptoms |
| Day-to-day personal care and supervision by facility staff, as in the admission agreement | Hospice aide visits for bathing and personal care when part of the plan of care. These add to the facility's care and do not replace it. |
| Helping with medicines the way RCFE rules allow | Medicines, equipment and supplies related to the terminal illness, and teaching on how comfort medicines are used |
| Watching for changes and calling the hospice | A nurse by phone day and night, and visits when needed |
| Keeping the family informed about daily life | Social work, chaplain support if wanted, and grief support for family for 13 months after a death |
We care for people wherever they call home, including nursing facilities, RCFEs and board-and-care homes, in coordination with facility staff.
Who pays for hospice in assisted living?
Medicare covers hospice care related to the terminal illness. Under Medicare, most people pay nothing for hospice care itself. There can be a copay of up to $5 per prescription for symptom medicines and 5% of the Medicare amount for inpatient respite care. Medicare does not pay room and board where you live.
That last sentence matters most in assisted living. The monthly fee to the facility stays the resident's responsibility, paid from income, savings, long-term care insurance or family help. Starting hospice does not lower the facility's bill and does not raise it on its own. If the facility charges by level of care, ask whether the resident's level will change as they decline.
Medi-Cal covers hospice. Regular Medi-Cal does not pay RCFE room and board either. See Medi-Cal and hospice and paying for care.
Can you have hospice in a memory care community?
Yes. In California a memory care community is an RCFE whose license carries a dementia-care designation, so the same rules apply: the community keeps the room, meals and daily supervision, and the hospice brings the nurse, hospice aide, social worker and chaplain to the resident. For the resident to stay through the end of life, the community needs the hospice care waiver or an exception on its license (22 CCR 87632 and 87633), the same as any other RCFE.
The person or their representative chooses the hospice, not the community. A community can tell you which hospices it has worked with; it cannot require one. Read hospice and dementia for when someone with dementia qualifies, and the dementia criteria for the clinical rule.
Is hospice the same as memory care?
No. Memory care is a place to live; hospice is a Medicare benefit that comes to wherever the person lives. A person can have both at once, and one does not replace the other.
| Memory care | Hospice | |
|---|---|---|
| What it is | An RCFE with dementia-trained staff and a secured setting, where the person lives | Comfort-focused care for the last months of life, brought to the person |
| Who pays | The resident, from income, savings, long-term care insurance or family; not Medicare | Medicare or Medi-Cal, with most people paying nothing for the hospice care itself |
| How long | For as long as the person lives there | In benefit periods, for as long as a doctor certifies eligibility |
| Who provides it | The community's own staff, around the clock | The hospice team, on visits, plus a nurse by phone 24 hours a day |
Both can continue together: the community keeps doing what it does, and the hospice adds the clinical care, the comfort medicines, the equipment and the support for the family.
What should you ask an assisted living facility about hospice?
Before hospice starts in assisted living, ask the facility whether it holds a hospice care waiver, whether residents on hospice can stay through the end of life, and how fees, medicines and information sharing will work:
- Do you hold a hospice care waiver from Community Care Licensing?
- Have you cared for residents on hospice through the end of life here? What would make you ask a resident to move?
- Can we choose any licensed hospice? (The choice belongs to the resident. A facility may suggest hospices it knows, but it should not require one.)
- How will your staff and the hospice share information from shift to shift?
- Who helps with medicines at night, and who calls the hospice if there is a change?
- Will the monthly fee change as care needs increase?
- Can family stay overnight near the end?
- Is there space for a hospital bed or other equipment in the room?
You can look up any RCFE's license, capacity and inspection history on the Department of Social Services care facility search. For questions to ask the hospice, see how to choose a hospice.
Common questions about hospice in assisted living
Can you be on hospice in an assisted living facility?
Yes. In California, a resident of an RCFE can receive hospice in the facility when the facility holds a hospice care waiver and can meet the resident's needs with the hospice's support. The hospice team comes to the resident.
Is RCFE the same as assisted living?
In California, yes for licensing purposes. RCFE, residential care facility for the elderly, is the license type. Assisted living, memory care and board and care are everyday names for homes that hold that license. Sizes range from six beds in a house to large communities.
Will Mom have to move to a nursing home?
Often not. Many residents stay in their RCFE through the end of life with hospice. A move may come up if the facility has no hospice care waiver or cannot safely meet the person's needs. Ask the facility directly and early. Read hospice in a nursing home.
Does hospice staff stay with the resident all day?
No. Hospice team members visit, and facility staff continue the daily care. During a symptom crisis, more intensive care can be provided when medically necessary. Some families also hire a private caregiver for extra hours.
Does hospice pay for assisted living?
No. Hospice, paid by Medicare or Medi-Cal, covers the hospice care: the team's visits, and the comfort medicines, equipment and supplies related to the terminal illness. It does not pay the facility's room and board or monthly fee, which stays the resident's responsibility.
Does the facility need a contract with the hospice?
The facility and the hospice agree on a written plan that says who does what for the resident, as the state rules expect. The resident still chooses the hospice. A facility can say which hospices it has worked with, but it should not require one.
When does someone with dementia in memory care qualify for hospice?
Under the Medicare guidance most hospices use, at FAST stage 7 (unable to walk, dress or bathe without help, with little speech) plus a complication in the past year such as aspiration pneumonia, a urinary infection with fever, sepsis, pressure sores or weight loss. The hospice nurse assesses at the community. Read when to call hospice for dementia.
Does the memory care community have to allow hospice?
A resident can elect hospice anywhere. Whether the community can keep the resident through the end of life depends on its license: it needs the hospice care waiver or an exception, and it must be able to meet the care needs with the hospice's help. Ask the administrator before you need the answer.
We have not chosen a facility yet. Does hospice matter in the choice?
It can. If you want the person to be able to stay in one place, choose a facility that has a hospice care waiver and experience with end-of-life care. See where hospice care happens.
For facility administrators and staff
Information on the waiver, shared care plans and coordination is on our page for assisted living and RCFE professionals.
About this page
- Written by
- Beta Hospice care team
- Medically reviewed by
- Oscar Chien, MD, Medical Director
- Last reviewed
- September 24, 2026
- Next review
- March 24, 2027
How we write and review this site
Sources
- California Department of Social Services: Community Care Licensing (opens in a new tab)
- California Legislative Information: Health and Safety Code section 1569.73 (opens in a new tab)
- California Department of Social Services: Care facility search (opens in a new tab)
- Medicare.gov: Hospice care coverage (opens in a new tab)
These sources support the general information on this page. For one person鈥檚 care and coverage, talk with the hospice team.
You do not have to decide alone.
Call (877) 258-7129 any time, or leave your number and someone from Beta's hospice team will call you. No decision is needed to call. Most families start with a question.
Only a hospice doctor, together with the person鈥檚 own doctor, can confirm hospice eligibility. A website cannot.
- A nurse answers 24 hours a day, 7 days a week
- You can stop hospice at any time
- You have the right to choose your hospice