End-of-Life Care in California Assisted Living: Staying in the Home

Often, yes. Assisted living communities and board and care homes are licensed in California as residential care facilities for the elderly (RCFEs). The state's regulations say the rules on who a home may keep are meant to allow residents to age in place in the least restrictive environment when appropriate.

There is a ceiling. Health and Safety Code section 1569.72 says no resident may be admitted or retained if the resident requires 24-hour skilled nursing or intermediate care. Hospice is the exception the law carves out. Under section 1569.73, a home may obtain a waiver from the Department of Social Services so that a resident diagnosed as terminally ill can remain, when the resident has a licensed, Medicare-certified hospice, the home can provide appropriate care and supervision, and the home and hospice have agreed on a care plan.

The waiver, the request to stay and the care plan are explained step by step in hospice in assisted living in California. This page covers what the last months involve and what to decide early.

Section 1569.73 keeps the roles apart. The hospice designs and provides the care, services and necessary medical intervention related to the terminal illness. The home continues its own work: the room, meals, supervision and help with daily activities. The statute says nothing in it expands the home's scope of care, and the care plan must limit the home's tasks to those an RCFE is allowed to do.

Hospice does widen what a home may accept. Under Title 22 section 87616, a home with a hospice waiver does not need a separate exception from the state for a restricted or prohibited health condition when the resident is terminally ill, is receiving hospice, and the treatment of that condition is specifically addressed in the hospice care plan.

A person who can no longer get out of bed is treated under the bedridden rules. Section 1569.72 requires a home that keeps a bedridden resident to notify the local fire authority no later than 48 hours afterward, and section 1569.73 says the hospice waiver does not remove that duty or the need for a fire clearance. See bedridden residents in California assisted living.

On cost, Medicare says, as of 2026, that you pay nothing for hospice care from a Medicare-approved hospice provider and a copayment of up to $5 for each prescription for outpatient drugs for pain and symptom management. Medicare also says it does not cover room and board when you get hospice care in your home or live in a nursing home, and that you may have to pay for room and board if you live in a facility and choose hospice. In a care home, the monthly rate continues, and it may rise if the home's own care tasks increase. Ask.

Title 22 section 87465 requires a home to telephone 911 immediately if an injury or other circumstance has resulted in an imminent threat to a resident's health, including an apparent life-threatening medical crisis. Wanting a quiet death at home does not by itself change that duty.

The exception is narrow. Under section 1569.73 and Title 22 section 87469, a home with a hospice waiver may notify the hospice agency instead of calling 911 when all of these are true:

• The resident is receiving hospice services from a licensed hospice agency.
• The resident has completed an advance directive or a request regarding resuscitative measures, such as a POLST or do-not-resuscitate form, asking to forgo resuscitation.
• The home has documented that its staff received training from the hospice on the expected course of the illness and the symptoms of impending death.
• The emergency shows symptoms of impending death and is directly related to the expected course of the terminal illness.

For an emergency that is not directly related to the expected course of the terminal illness, such as a fall with an injury, staff must call 911. A June 2025 notice from the Community Care Licensing Division adds that even when 911 is called, residents keep the right to accept or refuse medical treatment and transport to a hospital. The forms that carry those wishes are explained in POLST and advance directives in assisted living.

1. 1

   Ask about the waiver before it is needed

   Ask the home whether it holds a hospice waiver and whether there is room under it now. A home without one may not keep a resident on hospice.

2. 2

   Put wishes in writing with the doctor

   Ask the doctor about an advance health care directive and a POLST. Give the home copies for the resident's file and confirm that every shift knows where they are.

3. 3

   Name the decision maker

   The home and the hospice need to know who makes health care decisions if your relative cannot. After an emergency involving a resident who has these forms on file, staff must notify the hospice agency and the health care surrogate decision maker, if there is one.

4. 4

   Choose the hospice and meet the team

   Under Title 22 section 87633, the resident or the resident's health care decision maker contracts with the hospice, not the home on the resident's behalf. Ask the hospice how fast a nurse can come at night.

5. 5

   Talk to the roommate

   In a shared room, section 1569.73 requires the home to obtain the roommate's agreement to allow hospice caregivers into the room.

6. 6

   Ask what happens afterward

   Ask whom staff call first at the time of death and what the home needs from the family. Under Title 22 section 87211, the home must send a written report of a resident's death to the licensing agency and to the person responsible for the resident within seven days.

Staying is not always possible. Section 1569.73 says that when the hospice, the home or the resident determines that the resident's condition has changed so that continued residence will pose a threat to the health and safety of the resident or any other resident, the home may initiate a transfer. The eviction regulation, Title 22 section 87224, allows an urgent relocation of a hospice resident to a licensed health facility when the Department, the resident or surrogate, the hospice, a physician and the home jointly determine there is a health and safety risk.

The options at that point, and the steps a home must follow, are in when assisted living is not enough.

Hamssa Benrekia's background is in hospice, palliative care and home health, and she holds an RCFE Administrator Certificate. She has helped families whose relative was on hospice find a board and care home, and she knows many board and care homes and their owners in the South Bay and Harbor area of Los Angeles County. She does not provide hospice or medical care, and she does not choose the hospice agency. More topics are in the California Assisted Living Placement Guide. To talk through a situation, contact Hamssa.