Hospice in memory care homes: who does what

What is a memory care home in California?

Memory care is a residential care facility for the elderly (RCFE) that cares for people with dementia. It is licensed by the California Department of Social Services, not by the health department, and it is a non-medical home. Under state rules (22 CCR 87705), its staff must be trained in dementia care, exterior doors and gates that a resident could wander through must be monitored, and locked or delayed exits need state approval and the resident's or conservator's consent.

A home that advertises dementia care must have a written description of its dementia program and give it to you if you ask (22 CCR 87706). Ask for it before hospice starts. It tells you how the home handles changes in a resident's condition.

Can a resident stay in memory care through the end of life?

Often, yes. For a resident on hospice to stay as care needs grow, the home needs a hospice care waiver from the state (Health and Safety Code 1569.73) and must be able to meet the resident's needs with the hospice's help. The waiver, the written plan between the home and the hospice, and the questions to ask are explained on hospice in assisted living. Ask the administrator early, before a crisis.

The resident or their representative chooses the hospice, not the home. A home can say which hospices it has worked with; it should not require one.

Who does what when a memory care resident is on hospice?

The home keeps doing what it did before. The hospice adds clinical care, comfort medicines, equipment and family support. Neither replaces the other.

We care for people wherever they call home, including nursing facilities, RCFEs and board-and-care homes, in coordination with facility staff.

What changes day to day when hospice starts?

• A hospice nurse visits on a schedule set in the plan of care, and more often when needed. Staff and family can call the hospice nurse at any hour.
• A hospice aide may come for bathing and personal care on set days.
• Comfort medicines for the terminal illness are delivered to the home, often with a small supply for sudden symptoms. See the comfort kit.
• The home's staff call the hospice nurse, not 911, for most changes, as agreed in the plan.
• Medicines that no longer help with comfort may be stopped, after the hospice doctor, the resident's doctor and the family discuss it.
• The resident's daily routine, room and familiar staff stay the same.

How does hospice help with behavior changes?

In late dementia, new agitation, calling out, resisting care or sleeping all day often has a cause the person cannot name: pain, constipation, a full bladder, an infection, hunger, thirst, or too much noise. The hospice nurse looks for that cause first and treats it.

Calm, familiar routines, a quiet room, the same caregivers and simple choices come first. When distress continues, the hospice doctor may order a medicine for comfort, at the lowest dose that works, and the nurse checks how it is working. Read restlessness near the end of life.

What about falls?

Falls are common in late dementia, because walking and balance fail before the person understands they need help. Hospice cannot prevent every fall. The team can lower the risk with the home: a low bed, a mat beside the bed, a regular toileting schedule, good night lighting, and checking whether a medicine is adding to unsteadiness.

After a fall, staff should keep the resident comfortable and call the hospice nurse. The nurse assesses, treats pain, and decides with the family whether an X-ray or a hospital visit would help. Some homes have a policy to call 911 after every fall. Ask the home, before it happens, whether it will call the hospice nurse first when there is no emergency, and make sure the resident's POLST is in the chart.

What if the resident stops eating?

Eating less and losing weight are expected in late dementia. The body slows down and can no longer use food the way it did. Coughing at meals, holding food in the mouth or turning away from the spoon are signs that swallowing is getting harder.

The hospice team teaches careful hand feeding: small bites, soft or thickened foods, sitting upright, and stopping when the person shows they are done. The goal is comfort and enjoyment, not a calorie target. For feeding tubes in advanced dementia, read hospice care for dementia, and for the last days, when someone stops eating and drinking.

When do you call the hospice nurse, and when 911?

For anything about the illness, call the hospice nurse first, day or night. Call 911 for an emergency that has nothing to do with the illness, or when the resident has asked for emergency treatment and the hospice team knows.

If the hospice team has given you different instructions for this resident, follow them. Read hospice and the ER.

Who pays for memory care on hospice?

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.

So the memory care home's monthly fee stays the resident's or family's responsibility, paid from income, savings, long-term care insurance or family help. Hospice does not lower the fee. If the home charges by level of care, ask whether the level will change as needs grow. Regular Medi-Cal covers hospice but does not pay RCFE room and board. See Medi-Cal and hospice and paying for care.

When is someone with dementia ready for hospice?

Hospice is for people with a serious illness when a doctor certifies that life expectancy is six months or less if the illness runs its usual course. Our medical director and your doctor make that determination. A website cannot.

For the signs that it may be time to ask, read hospice care for dementia and when to call hospice for dementia. The stages are described in the last stages of dementia, and clinicians can see the FAST scale.

Memory care homes in the Inland Empire

Beta Hospice cares for residents of memory care homes, assisted living and board and care homes across San Bernardino and Riverside counties, and in Los Angeles, Orange and Ventura counties. Before choosing a home, look up its license, capacity and inspection reports in the state's care facility search (opens in a new tab). See our service area.

Common questions