Did you know that your terminally ill loved one can receive hospice care, or end-of-life care, without leaving their assisted living community? In response to seniors’ desires, many assisted living communities embrace an aging-in-place philosophy. This means assisted living and hospice caregivers work as a collaborative team to provide residents with increased levels of care, within limits, in their assisted living community. Medicare typically helps cover some hospice care costs, which can be a comfort to families. And while hospice care is different from palliative care, it can make seniors more comfortable and increase the time they have left.
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There are many benefits to receiving hospice care in assisted living. Hospice care teams offer physical and emotional comfort to seniors during their final months, weeks, or days. They also support family members as they navigate end-of-life decisions. By receiving these end-of-life services in assisted living, residents can spend their last days in the comfort of a familiar place. In order for residents’ end-of-life needs to be met within assisted living, medical staff must visit the community to provide hospice services.
A common misconception is that seniors must go to another location, such as a hospice care home, to receive hospice services. While there are facilities devoted solely to hospice, the vast majority of people receive hospice care in their place of residence, says Jon Radulovic, communications advisor at Sentara Health and former vice president of communications at the National Hospice and Palliative Care Association in Alexandria, Virginia.
“Hospice is associated with imminent death, and it’s not accurate,” says Radulovic. “It’s well-suited for the final months of life, not days.”
Hospice care services include:
Four states — Idaho, Mississippi, Montana, and North Dakota — don’t allow hospice care to be provided in an assisted living community, according to Radulovic. In other states, hospice care is allowed at the discretion of the senior community.
Some states require assisted living communities to inform a regulatory agency once someone needs hospice. This is typically done by filing a waiver, which establishes that an agreement of care has been created between the hospice provider and the assisted living community.
If possible, research hospice care facilities in advance, and don’t put off talking with staff or caregivers at your loved one’s assisted living community, says Radulovic. Terminally ill residents and their families have a better chance of finding suitable hospice care if they seek providers sooner rather than later.
Once a resident begins hospice care, the assisted living community and interdisciplinary team work to create an organized care plan. This includes answering detailed questions, such as:
“Hospice focuses on the person and not the disease. It makes the patient’s wishes a priority in the care plan. Hospice focuses on quality of life and helping a person live as fully as possible despite a terminal illness,” says Radulovic.
Medicare and most private health insurance plans will cover hospice care. Medicare specifically will cover hospice care at a Medicare-certified nursing facility or through a Medicare-certified hospice agency. Treatments include what’s known as comfort care, or care that eases pain and alleviates discomfort when a patient’s illness is no longer responding to treatment. The Medicare hospice benefit covers the care team, equipment, medications, and therapies.[01]
“It’s designed to be all-inclusive,” says Radulovic.
To qualify for this Medicare benefit, a person must meet the following requirements:
The Medicare benefit covers care for two 90-day periods in hospice, which is followed by an unlimited number of 60-day periods.[02] At the start of each care period, a doctor must reassess whether the patient has six months or less to live.[01]
There’s no deductible for hospice services, although sometimes there’s a small co-payment for medications. The Veterans Administration also provides hospice assistance for veterans.[03] For those who qualify, Medicaid can provide hospice coverage, as well.[04]
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Although hospice and palliative care are similar in reducing pain and enhancing a person’s quality of life in assisted living, there are distinct differences between the two types of care.
Palliative care doesn’t have time restrictions, but hospice care in assisted living is intended for patients who have six months or less to live.
Hospice patients decline curative treatments, as hospice care caters to those with a terminal prognosis. The goal of hospice is to make a person’s final days as comfortable, meaningful, and peaceful as possible.
Overall, assisted living hospice care provides symptom management, whereas palliative care aims to provide symptom improvement and cures.
Despite what many people believe, choosing hospice care in assisted living does not mean someone is “giving up,” says Radulovic. “It’s real medicine and real care. Hospice can increase [the] quality of life, and in some cases, even length.”
In a study of nearly 4,500 Medicare beneficiaries, the average survival period was 29 days longer for hospice patients than non-hospice patients. Hospice patients with congestive heart failure, lung cancer, pancreatic cancer, and colon cancer had a significantly longer average survival period than patients who opted out of hospice care.[05]
A doctor’s referral is generally all that’s needed for a patient to become eligible for hospice. Once it begins, hospice care in the patient’s assisted living home can be stopped at any time if they decide they want to pursue curative treatments.
By working to meet all the patient’s needs during end-of-life care, hospice providers help bring peace of mind to the patient’s family. Hospice services in assisted living offer this collective care through the following:
Once someone is enrolled in hospice, the provider organizes and manages all aspects of care by creating a comprehensive plan in consultation with the assisted living community and family.
All medical care is focused on helping patients get maximum enjoyment out of their remaining time. The goal is to minimize pain and keep other symptoms under control. Sometimes alternative therapies, such as massage therapy are available. Each care coordinator may offer different services, so it’s best for families to reach out to them with any specific service requests.
The following therapies and services have all been shown to have a short-term benefit:[06]
Hospice works with assisted living communities to arrange assistance with activities of daily living for seniors like bathing, dressing, and eating.
Hospice care provides all necessary supplies and equipment.
These professionals can help patients and their families manage anticipatory grief. After a death, some programs offer bereavement services to help families through the grieving process.
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Hospice care in assisted living is intended to give residents a comfortable and dignified end of life, and this happens thanks to the efforts of a variety of individuals:
Hospice nurses play a particularly pivotal role by working with the staff of the assisted living communities to coordinate care plans. Although hospice nurses administer care, they do more than provide medications like painkillers and sedatives. They educate the patient’s primary caregiver about their loved one’s condition, provide ongoing emotional support, and counsel the patient and their loved ones.
“A hospice team has skills specific to someone who is at the end of their life,” says Radulovic. “A hospice nurse can be tuned in to [the patient’s] unique needs.”
Hospice also provides respite care, which allows loved ones to take a break from caregiving. Volunteers are scheduled regularly to help with errands and meal delivery. The care plan may be adjusted weekly depending on team members’ availability and the patient’s updated needs. The hospice team may also employ a counselor who can help you communicate with your loved one entering hospice care and identify the essential documents you may need.
If your loved one is ready for end-of-life care, A Place for Mom can guide you in your search for hospice care facilities near you that coordinate with assisted living communities. Begin a no-cost consultation with a Senior Living Advisor at A Place for Mom to receive a tailored list of communities that meet your loved one’s specific needs and preferences.
Key Takeaways
Centers for Medicare and Medicaid Services. Hospice care. Medicare.gov.
Centers for Medicare and Medicaid Services. Medicare hospice benefits. Medicare.gov.
U.S. Department of Veterans Affairs (2022). Geriatrics and extended care.
Centers for Medicare and Medicaid Services. Hospice benefits. Medicaid.gov.
Connor, S., Pyenson, B., Fitch, K., Spence, C., & Iwasaki, K. (2007). Comparing hospice and nonhospice patient survival among patients who die within a three-year window. Journal of Pain and Symptom Management.
Zeng, Y. S., Wang, C., Ward, K. E., Hume, A. L. (2018, August 2). Complementary and alternative medicine in hospice and palliative care: A systematic review. Journal of Pain and Symptom Management.
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