Late-Stage Dementia and Hospice in Memory Care: Can Your Parent Stay?

The Alzheimer's Association says the late stage of Alzheimer's disease may last from several weeks to several years, and that intensive, around-the-clock care is usually required. It lists what a person in this stage usually experiences: difficulty eating and swallowing, needing help to walk and eventually being unable to walk, needing full-time help with personal care, and being vulnerable to infections, especially pneumonia.

The National Institute on Aging adds detail that matters for choosing or keeping a home. A person who can no longer chew and swallow easily is at higher risk of choking. A person who stops walking or stays in one position too long often develops sores or other skin problems. And a person in the final stages may not be able to say they are in pain, showing it through groans, grimaces or guarding a part of the body.

Other dementias follow their own course, and your parent's doctor is the person to ask about theirs. The earlier stages are described in dementia stages and care needs.

Memory care in California is provided in assisted living communities and board and care homes, licensed as residential care facilities for the elderly (RCFEs). They are non-medical homes, and Title 22 sorts health conditions into those a home may care for under set conditions and those it may not accept or keep without an exception. Several late-stage needs fall on those lists:

Two routes exist for a prohibited or restricted condition. Under section 87616 a home may send the state a written exception request with medical documentation and its plan for meeting the resident's needs. The other route is hospice, described below. Whatever the rules allow, each home also decides what its staff and building can manage, so two licensed homes can give different answers about the same person.

Hospice is comfort-focused care for a person with a terminal illness, delivered where the person lives. The Alzheimer's Association says a physician's referral is needed to begin, and suggests telling the physician who is providing care if you believe your family member needs hospice services. Whether your parent is at that point is a medical judgment, and this page does not make it.

As of 2026, Medicare says a person qualifies for hospice care when all of these are true:

• The hospice doctor and the person's regular doctor, if they have one, certify that the person is terminally ill, with a life expectancy of 6 months or less.
• The person accepts comfort care in place of care to cure the illness.
• The person signs a statement choosing hospice care over other Medicare-covered treatments for the terminal illness and related conditions.

Medicare also says hospice does not end at six months. A person can continue as long as the hospice medical director or hospice doctor recertifies, after a face-to-face meeting, that they are still terminally ill. That matters in dementia, where the late stage can be long.

Yes, if the home holds a hospice waiver. Health and Safety Code section 1569.73 lets an RCFE obtain a waiver from the Department of Social Services so that a resident diagnosed as terminally ill can remain, with a licensed, Medicare-certified hospice providing the care related to the terminal illness. How the waiver works, who chooses the hospice and who does what are covered in hospice in assisted living in California.

The point that matters most in late-stage dementia is in Title 22, section 87633. A home with the waiver does not need a separate exception for a restricted or prohibited health condition when the resident is terminally ill, is receiving hospice care in line with the rules, and the treatment of that condition is addressed in the hospice care plan. A resident on hospice who is bedridden may stay if the home meets the bedridden rules, which are explained in bedridden residents in assisted living.

The same section requires the hospice to train the home's staff before hospice care begins, and names the typical needs: turning and incontinence care to prevent skin breakdown, hydration and infection control.

There are limits. Section 1569.73 says the home may start a transfer if the hospice, the home or the resident determines that staying would threaten the health and safety of the resident or others. The regulations also leave the state free to require relocation of a terminally ill resident whose needs are not being met. Home staff may not perform any procedure that by law only a licensed professional may perform.

On cost, Medicare says its hospice benefit does not cover room and board. The home's monthly rate continues.

The Alzheimer's Association says that although a person in the late stage typically loses the ability to talk and express needs, research tells us some core of the person's self may remain, and that the world is now experienced mainly through the senses. Its suggestions include playing their favorite music, reading portions of books that have meaning for them, looking at old photos together, preparing a favorite food, rubbing lotion with a favorite scent into the skin, brushing their hair and sitting outside together on a nice day.

The National Institute on Aging says much the same: even in advanced dementia a person may benefit from emotional and spiritual connection, touch or massage can be soothing, and just being present can be calming. If you think your parent is in pain, both organizations say to raise it with the health care team promptly. More on visits at every stage is in visiting a parent in memory care.

Hamssa Benrekia is a senior living placement specialist in Torrance who works with families in the South Bay and Harbor area of Los Angeles County. Her background includes hospice, palliative care and home health, and she has helped families whose relative was on hospice find a board and care home. For memory care placement, she can ask homes the questions above before you tour. She does not provide hospice care, choose the hospice agency or decide what a home may keep.

To talk through what your parent needs now and may need later, contact Hamssa. Other topics are in the California Assisted Living Placement Guide.