Hospice in Assisted Living: Can a Resident Stay in a California RCFE?

The National Institute on Aging describes hospice as an approach to care that is not tied to a specific place. It focuses on comfort rather than cure. Medicare says a person can usually get hospice care at home or in a facility where they live, such as an assisted living facility or a nursing home.

In California, assisted living communities and board and care homes are licensed as residential care facilities for the elderly (RCFEs). They are non-medical homes, and hospice is a specific exception written into the law.

Health and Safety Code section 1569.73 lets an RCFE obtain a waiver from the Department of Social Services for two purposes. One is to allow a resident who has been diagnosed as terminally ill to remain in the home. The other is to allow a terminally ill person to become a resident, if that person is already receiving hospice services and would keep receiving them without disruption after moving in.

The California Department of Aging sums up the conditions: the home is in substantial compliance with licensing requirements, the resident receives care from a licensed hospice agency, and the home has the capacity to meet the resident's needs.

The waiver belongs to the home, not to the resident. Under the state's RCFE regulations, a licensee sends the Department of Social Services a written request that states the maximum number of terminally ill residents the home wants to have at any one time. The department will not approve a request unless the home is in substantial compliance with RCFE law and shows it can meet the care and supervision needs of terminally ill residents.

That is why two homes can give different answers. One may hold no waiver. Another may hold one and already be at its number. California Advocates for Nursing Home Reform (CANHR) notes that a home must tell residents in writing, at or before admission, about any limits on who it can keep, and it gives the hospice waiver as an example.

Once a home has the waiver, the resident, or the person who makes health care decisions for them, signs a written request to be accepted or to stay while receiving hospice. The home notifies the department in writing within five working days after hospice begins, or after admitting someone already on hospice.

The waiver also changes what conditions a home may handle. The regulations say no separate exception request is needed for a restricted or prohibited condition when the resident is terminally ill, is receiving hospice in line with the rules, and the treatment of that condition is addressed in the hospice care plan. The general rules are in health conditions an RCFE may accept.

The law keeps the two roles apart. Section 1569.73 says the hospice designs and provides the care, services and necessary medical intervention related to the terminal illness, to supplement the care and supervision the home provides.

The regulations require a written hospice care plan for each resident, developed by the hospice agency and agreed to by the home and the resident before hospice services start in the home. The plan must give the hospice's 24-hour emergency number, describe the type and frequency of hospice services and of the tasks the home's staff will do, and name the licensed professional at the hospice who controls and supervises the storage and administration of controlled drugs. The hospice must train the home's staff on the resident's needs before hospice care begins.

These points come from section 1569.73 and Title 22 sections 87632 and 87633.

When a home cannot meet a person's needs even with hospice, a skilled nursing facility is the usual alternative. Our comparison of assisted living and nursing homes explains the difference.

• The hospice agency must be licensed by the state and certified by the federal Medicare program.
• Hospice is contracted for by the resident or the resident's health care decision maker, not by the home on the resident's behalf.
• If the room is shared, the roommate signs a statement agreeing to give hospice caregivers, family, friends and clergy access to the shared space. If the roommate withdraws that agreement, the home must make other arrangements that fully meet the hospice resident's needs.
• A resident on hospice who is bedridden may live in the home if it meets the state's separate rules for bedridden residents.
• A home with a waiver need not call emergency services in a life-threatening emergency if it notifies the hospice agency instead and three conditions are met: the resident is on hospice with a licensed agency, the resident has completed an advance directive asking to forgo resuscitation, and staff have been trained by the hospice on the expected course of the illness.
• If the hospice, the home or the resident decides that staying would threaten the health and safety of the resident or others, the home may start a transfer. The department can also require relocation when a resident's needs are not being met.

As of 2026, Medicare says a person qualifies when the hospice doctor and their regular doctor certify a terminal illness with a life expectancy of 6 months or less, and the person accepts comfort care instead of care to cure the illness.

The Centers for Medicare and Medicaid Services lists what the benefit includes: nursing care, medical equipment and supplies, drugs to manage pain and symptoms, hospice aide and homemaker services, medical social services and counseling.

Medicare says it does not cover room and board when a person gets hospice at home or lives in a facility. So the home's monthly rate continues, and CANHR notes that specialized services such as hospice care are more costly in an RCFE. Ask each home whether its rate changes when hospice begins. More on what Medicare does and does not pay is in does Medicare pay for assisted living.

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