Hospice in assisted living in California

First, the words: RCFE, assisted living, board and care

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 the hospice care waiver is

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

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 what

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.

Questions to ask the facility

• 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?

Common questions

For facility administrators and staff

Information on the waiver, shared care plans and coordination is on our page for assisted living and RCFE professionals.