Finding a board and care home for a relative on hospice

Many families hear the word hospice and picture a building. The National Institute on Aging describes it differently: hospice is an approach to care, so it is not tied to a specific place. It can be given at home, in an assisted living facility, in a nursing home or in a separate hospice center.

A team member visits regularly, and someone is usually reachable by phone at any hour. The team does not stay around the clock, though. When a person is at home, the day-to-day care falls to family and friends.

That gap is why families start looking at board and care homes, which California licenses as RCFEs, its residential care license for people 60 and over. These are small homes, often a house on an ordinary street, where staff are on hand day and night to help with meals, bathing, dressing and turning in bed. The hospice team keeps visiting there, the same way it would visit a private house.

Under Medicare, the hospice doctor and your relative's regular doctor certify that the illness is terminal, with a life expectancy of 6 months or less.

The Centers for Medicare and Medicaid Services lists what the benefit covers. It includes nursing care, medical equipment and supplies, drugs for pain and symptom control, hospice aide and homemaker services, social work, and counseling for the family.

Here is the part that surprises people. Medicare says it does not cover room and board when a person gets hospice care at home or lives in a facility. In a board and care home, that means two separate arrangements: hospice for the medical side, and the home's monthly rate for the room, meals and daily care. Medicare does cover short inpatient stays the hospice team arranges, for symptoms that cannot be managed where the person lives or to give the usual caregiver a rest. A respite stay is limited to 5 days at a time, and the person may owe 5 percent of the Medicare-approved amount. Ask the hospice agency what applies to your relative. Our guide to board and care costs explains how those monthly rates work.

Not every home can keep or accept a resident on hospice. Under California Health and Safety Code section 1569.73, an RCFE may obtain a hospice waiver from the Department of Social Services. With the waiver, the home may let a resident who becomes terminally ill stay, or accept a new resident who is already receiving hospice services.

The law and the state's regulations attach conditions. Among them:

• The hospice agency must be licensed by the state and certified by Medicare.
• The resident, or the person who makes health care decisions for them, contracts with the hospice agency. The home does not do that on the resident's behalf.
• The home and the hospice agree on a written care plan that spells out which tasks each one handles and how often.
• If the room is shared, the roommate must agree to hospice caregivers coming in.
• When a home asks for a waiver, it states the largest number of terminally ill residents it wants to have at one time. A home with a waiver can still be full.

Hamssa Benrekia holds an RCFE Administrator Certificate, and her background includes palliative care, hospice care and home health. She has helped families whose relative was on hospice find a board and care home. She refers families only to homes licensed by the State of California, and you can check any home's license yourself.

If your relative is in a hospital or a skilled nursing facility right now, see placement after a hospital discharge. Hamssa has coordinated with case workers and social workers during discharge.

1. 1

   A conversation

   Hamssa asks about care needs, health conditions, preferences, daily habits and the monthly budget. Tell her whether hospice has started and which agency is involved.

2. 2

   A short list

   She puts together a short list of homes that fit, and asks each one whether it can accept a resident on hospice now.

3. 3

   Tours together

   She schedules the tours and goes with you. Bring the questions above, and our tour checklist.

4. 4

   Talking terms

   She helps you talk through the rate and the admission agreement with the home before you sign.

5. 5

   After the move

   She checks in with you once your relative has settled.

Call, text or WhatsApp Hamssa at 310-594-0694, or send a message. It helps to have the hospice agency's name if there is one, a current medication list, where your relative is today, and a monthly budget.

Hamssa does not give medical advice. Questions about medications, comfort, or whether hospice is the right choice belong with your relative's doctor and the hospice team.