Hospice when you live alone or have no caregiver

Can you have hospice if you live alone?

Yes. Under Medicare, a person can choose hospice when a doctor certifies a terminal illness (42 CFR 418.20). There is no rule that a family member must live in the home. 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.

What changes when you live alone is the planning. At the first visits, the nurse and social worker look at how well you move, think, eat and take your medicines, and who is around you (42 CFR 418.54). Together you make a safety plan, and the team updates it as things change.

Tell us at the first call that you live alone. You do not need to have it all worked out before you call.

What does hospice provide when no one lives with you?

Continuous home care adds nursing hours at home only when medically necessary during a symptom crisis. It is not a way to have someone live in.

What is in a safety plan?

The nurse and social worker build this with you, and write it into the plan of care. Each part answers one question.

• Who checks in, and when. One person you name calls or stops by every day at set times, and knows what to do if you do not answer.
• Who helps between visits. Family, a hired caregiver, or IHSS hours for meals, bathing, housework and errands.
• Neighbors. One or two people nearby who know your situation and can come quickly.
• How people get in. A lockbox with a code, or a key with a trusted neighbor, so the nurse or emergency crew can enter without breaking a door.
• The 24/7 nurse line. The hospice number by the bed, saved in your phone, and on the refrigerator. A hospice nurse answers the phone 24 hours a day, 7 days a week, and can visit when needed.
• Medicines. A pill organizer or blister packs, the comfort kit stored safely, and a clear list of what to take and when.
• Your wishes on paper. A POLST form and an advance directive where they can be found, and a named health care agent.
• When a move may be needed. The signs that living alone is no longer safe, and where you would go: family, a care home or a nursing facility.

Who pays for help between visits?

Hospice does not pay for a caregiver to stay in the home. These are the usual ways people fill the hours:

In-Home Supportive Services (IHSS). A county Medi-Cal program that pays a caregiver for a set number of hours each month, for people with Medi-Cal who need help to stay safely at home. The caregiver can be a relative or friend. Apply through the county IHSS office. Approval can take weeks, so start early. See IHSS and hospice.

Hired help. Home care agencies and private caregivers charge by the hour. Long-term care insurance sometimes pays part.

Local aging services. The California Department of Aging's line, 1-800-510-2020, connects you to your county's Area Agency on Aging, which can point you to meals, in-home help and caregiver programs. You can also dial 211 for local services.

Our social worker helps you sort through these and start the applications.

Can hospice send someone to stay during a crisis?

Only for a medical crisis, and only for a short time. Continuous home care is provided only when medically necessary during a symptom crisis, such as pain or breathlessness that the usual medicines are not controlling. A nurse stays for long stretches until the crisis settles (42 CFR 418.204). General inpatient care, a short stay in a hospital or inpatient unit, is also only when medically necessary during a symptom crisis that cannot be managed at home (42 CFR 418.108).

Hospice does not provide either one just because a person lives alone. Respite care is a short stay of up to 5 days at a time that gives a family caregiver a rest, so it may not fit when there is no caregiver. Ask the team. See 24-hour care and levels of care.

When is living alone no longer safe?

Many people who live alone on hospice reach a point where they need someone with them most of the time. These are common signs. If any is true, call the nurse and talk about the next step.

• Falls, or trouble getting to the bathroom safely
• Confusion, forgetting medicines, or taking them twice
• Not able to get food or drinks, or make meals
• Too weak to answer the door or reach the phone
• Spending most of the day in bed
• Symptoms at night that need someone there
• Not able to use oxygen or other equipment safely

What happens if a move is needed?

The choice stays yours. The team talks it through with you and your family, and hospice care continues wherever you go. We care for people wherever they call home, including nursing facilities, RCFEs and board-and-care homes, in coordination with facility staff.

Options include moving in with family, a residential care facility for the elderly (RCFE), a board-and-care home, or a nursing facility. Medicare does not pay room and board where you live. Medi-Cal can pay for a nursing facility, and some care homes take the Medi-Cal Assisted Living Waiver. See board and care homes, hospice in assisted living and nursing home room and board.

What if death happens when no one is there?

It can happen, even with a good plan, and it is no one's fault. Some people who live alone say plainly that they accept this. Talk about it with the team and the people who check in on you, so everyone knows what you want.

If someone finds that you have died, they should call the hospice line, not 911. Call 911 only if there are signs of an injury, violence or an overdose. A hospice nurse comes to the home, and the hospice makes any report the law requires. The nurse also helps with the next steps, including calling the funeral home you chose. A POLST form and the hospice number in plain sight help. See when someone dies at home.

Common questions

More guides

Read what hospice does and does not provide, where hospice care happens, dying at home and the comfort kit.