Hospice in a Board and Care or Assisted Living Home: Can Mom Stay Where She Lives?

Quick answer: Often, yes. In California, a board and care or assisted living home can keep a resident on hospice, or accept someone already on hospice, if the home has a hospice care waiver from the state. Hospice is a service that comes to your parent, wherever they live. Medicare pays for hospice care, but not for the care home’s room and board, so the monthly bill keeps going.

Maybe the doctor just said the word “hospice,” and your stomach dropped. Maybe Mom has lived in her care home for two years, and the caregivers there feel like family. The first thing you want to know is simple: does she have to move?

In many cases, she doesn’t. This guide explains how hospice works in a California care home, what Medicare pays for, and what to ask now. It’s general information, not medical, legal or financial advice. Your parent’s doctor and hospice team are the right people for medical questions.

The short version

• Hospice is comfort care for someone with an illness that can’t be cured. It comes to your parent’s home, including a care home.
• In California, a board and care or assisted living home needs a hospice care waiver from the state to keep or accept residents on hospice.
• Your family chooses the hospice agency, not the care home.
• Medicare covers hospice care, but not room and board. You still pay the care home each month.
• Licensed care homes in the region typically cost $4,000 to $15,000 a month.
• Ask the home about hospice now, even if hospice feels far away.

What is hospice, and where can Mom get it?

Hospice is end-of-life care for people with illnesses that can’t be cured. The goal is comfort: managing pain and other symptoms, and supporting the person and the family (Medicare.gov).

Hospice is not a place. It’s a team that comes to your parent. Medicare says you can usually get hospice care in your home or another place where you live, like an assisted living facility or a nursing home (Medicare.gov). So if Mom lives in a board and care home or an assisted living community, hospice can often come to her there.

To get Medicare’s hospice benefit, the hospice doctor and your parent’s regular doctor (if they have one) certify that your parent is terminally ill, with a life expectancy of six months or less. Your parent also chooses comfort care instead of care to cure the illness (Medicare.gov). Hospice can continue past six months if the hospice doctor recertifies that your parent is still terminally ill.

Can Mom stay in her board and care or assisted living home on hospice?

Often, yes. In California, both board and care homes and assisted living communities are usually licensed as an RCFE (Residential Care Facility for the Elderly). California law lets an RCFE keep a resident who is terminally ill, or accept a new resident who is already on hospice, when certain conditions are met (California Health and Safety Code 1569.73).

The big one: the home needs a hospice care waiver from the California Department of Social Services. To get it, the home has to show it can meet the care needs of residents on hospice and say it is willing to add care staff if the hospice care plan calls for it (Title 22, Section 87632).

Some other rules families should know (Title 22, Section 87633):

• Your family picks the hospice. Your parent, or the person who makes health care decisions for them, contracts with the hospice agency. The care home doesn’t sign it for them. The hospice must be licensed by the state and certified by Medicare.
• There is a written hospice care plan. The hospice writes it, and the home, your parent (or their decision maker) and the hospice agree to it before hospice starts in the home. It spells out who does what.
• Hospice trains the home’s staff. The hospice gives the staff training on your parent’s needs before hospice care starts.
• A roommate has to agree. If Mom shares a room, her roommate signs a statement agreeing to let the hospice team and family in. If the roommate changes their mind, the home has to make other arrangements that meet Mom’s needs.
• More care needs may be OK. With a waiver and a hospice care plan that covers it, a home may be able to care for some health conditions it normally couldn’t.

When might Mom need to move?

Sometimes a move still happens. The law lets the hospice, the care home or the resident start a transfer if your parent’s condition changes so that staying would put them or other residents at risk (California Health and Safety Code 1569.73). The state can also require a move if a resident’s needs aren’t being met (Title 22, Section 87633).

A move is more likely if:

• The home doesn’t have a hospice waiver.
• Your parent needs more hands-on help than the home’s staff can give, even with the hospice team’s visits.
• Your parent becomes bedridden and the home isn’t set up for bedridden residents. California has separate rules for that, including fire safety rules (Title 22, Section 87633).

If the home tells you your parent has to move, our guide The Care Home Says Mom Has to Move explains notices and next steps.

Can Mom move into a care home if she’s already on hospice?

Yes, it’s possible. California law allows a home with a hospice waiver to accept a new resident who is already on hospice, as long as hospice continues without a break (California Health and Safety Code 1569.73).

Maybe Dad has been on hospice at your house, and the care has become too much for one person. A small board and care home with a hospice waiver can give him caregivers around the clock, while the same hospice team keeps visiting. Tell us he’s on hospice when you call, so we only suggest homes that can accept him.

Who does what when hospice comes to a care home?

• Care home staff. What they usually do: Daily care: meals, bathing, dressing, turning, keeping Mom clean and comfortable, help with medicines, watching her day and night.
• Hospice nurse. What they usually do: Visits, pain and symptom control, updates the care plan, supervises controlled pain medicines.
• Hospice aide. What they usually do: Extra help with bathing and personal care on visit days.
• Hospice social worker and chaplain. What they usually do: Emotional and spiritual support for your parent and your family.
• Your family. What they usually do: Chooses the hospice, signs papers, visits, and speaks up for your parent.

A hospice nurse and doctor are on call 24 hours a day, 7 days a week (Medicare Hospice Benefits booklet). The hospice team doesn’t move in. The care home’s caregivers are still the ones with your parent most of the day and night.

Who pays for hospice in a care home?

Medicare Part A covers hospice care from a Medicare-approved hospice. The hospice plan of care can include nursing care, medical equipment like a hospital bed or wheelchair, medical supplies, drugs for pain and symptoms, hospice aide visits, social worker services, and grief support for the family (Medicare.gov; Medicare Hospice Benefits booklet). Your parent may pay a copay of up to $5 for each prescription for pain and symptom control.

The surprise: Medicare’s hospice benefit doesn’t pay for room and board where your parent lives. You may have to pay for room and board if you live in a facility and choose hospice care (Medicare.gov). That means the care home’s monthly bill keeps going. Some homes also raise the monthly rate as care needs grow, so ask about that up front.

Licensed care homes in the greater Sacramento region typically cost $4,000 to $15,000 a month. A few homes charge less, but a price under $4,000 a month is rare. These are planning ranges, not quotes.

• Board and care, shared room. Typical monthly range: $5,000 to $7,000.
• Board and care, private room. Typical monthly range: $6,000 to $9,000.
• Assisted living, studio, light care. Typical monthly range: $5,500 to $8,000.
• Memory care. Typical monthly range: $8,000 to $13,000.
• High care needs. Typical monthly range: $10,000 to $15,000.

Families usually pay the care home with savings, pensions, Social Security, long-term care insurance, or VA benefits. Our guide Does Medicare Pay for Assisted Living? explains what Medicare does and doesn’t cover.

What about a break for the family?

If your parent is on Medicare hospice and lives at home with you, the hospice team can arrange short-term inpatient respite care in a Medicare-approved facility, for up to 5 days at a time, so you can rest (Medicare Hospice Benefits booklet). You may pay 5% of the Medicare-approved amount for that stay (Medicare.gov). Ask the hospice team first. Our respite care guide covers other short-stay options.

What should you ask the care home about hospice?

Ask these early, even if hospice feels far off. It’s much easier to know the answers before you need them.

• Do you have a hospice care waiver from the state?
• If my parent shares a room, how do you handle the roommate agreement?
• What would make you say my parent has to move?
• Can you care for a resident who is in bed most of the day?
• Will the monthly rate change as care needs grow?

Papers to have ready:

• Your parent’s advance health care directive, if they have one
• Power of attorney for health care, or the name of the health care decision maker
• A current list of medicines and doctors
• Medicare card and any other insurance cards

California law has a special rule here. When a resident is on hospice and has an advance directive saying they don’t want resuscitation, a home with a hospice waiver can call the hospice instead of 911 in a life-threatening emergency, if the staff have had the hospice’s training (California Health and Safety Code 1569.73). Talk with your parent’s doctor and hospice team about what your parent wants. Our guide Power of Attorney and Moving Mom or Dad Into Care explains the papers families should have ready.

If this, then that:

• If Mom’s home has a hospice waiver, then hospice can usually come to her there. Choose a hospice agency with her doctor’s help.
• If the home doesn’t have a waiver, then ask whether it plans to get one, and start looking at homes that have one.
• If Dad is on hospice at your house and the care is too much, then ask about a small home with a hospice waiver, or a short respite stay through hospice.
• If your parent needs a nurse around the clock, then the hospice and hospital teams may suggest a skilled nursing facility or an inpatient hospice setting.

Local help for Sacramento and Placer families

• Agency on Aging Area 4 gives free information to older adults and families in Sacramento and Placer counties: (916) 486-1876 or (800) 211-4545 (Agency on Aging Area 4).
• HICAP gives free Medicare counseling, including questions about hospice coverage: (916) 376-8915 or (800) 434-0222 (Agency on Aging Area 4).
• Long-Term Care Ombudsman helps people who live in care homes, and their families, with concerns about care or rights: (916) 376-8910 (Agency on Aging Area 4).

How Nonna Placements works: Nonna Placements is free to families. The home pays our fee when someone moves in, so families never pay us. You can choose any home. If the first home doesn’t work out, we find another for free. This article is general information, not medical, legal or financial advice.

Is Mom on hospice, or getting close? Call or text us

You don’t have to figure this out alone. Tell us where your parent lives now and what the doctor has said. We can help you find a home that accepts hospice. If you’re leaning toward care at home instead, call or text us and we can help you find in-home care options.

Nonna Placements helps families across California, with a focus on Placer and Sacramento counties. We only suggest homes we’ve seen ourselves. We can come on tours with you. For out-of-state families, we offer video tours. It’s free to your family, because the home pays our fee.

Call or text (916) 261-2644 or email roberto@nonnaplacements.com. We reply within 1 hour, 24/7.

Related reading: Does Medicare Pay for Assisted Living? · The Care Home Says Mom Has to Move · Respite Care in Sacramento and Placer · Power of Attorney and Moving Mom or Dad Into Care · Senior living in Sacramento

Sources

• Medicare.gov, Hospice care coverage (checked October 31, 2026): medicare.gov
• Medicare.gov, Medicare Hospice Benefits booklet (checked October 31, 2026): medicare.gov
• California Health and Safety Code Section 1569.73, Hospice waiver for residential care facilities for the elderly (checked October 31, 2026): leginfo.legislature.ca.gov
• California Code of Regulations, Title 22, Section 87632, Hospice Care Waiver (checked October 31, 2026): law.cornell.edu
• California Code of Regulations, Title 22, Section 87633, Hospice Care for Terminally Ill Residents (checked October 31, 2026): law.cornell.edu
• Agency on Aging Area 4, Contact us, Placer County services and Long-Term Care Ombudsman (checked October 31, 2026): agencyonaging4.org

About the author

Roberto Hategan is the CEO & Founder of Nonna Placements, a senior placement service in Granite Bay serving families across California, with a focus on Placer and Sacramento counties. We only suggest homes we’ve seen ourselves. Contact: roberto@nonnaplacements.com

Photo credits: Ron Lach, Dilan Aktay and Taryn Elliott, via Pexels, Pexels License.