Quick Answer
Almost anywhere they already live: their own home, an adult family home, assisted living, memory care, or a nursing facility, plus short stays in a hospice care center or hospital when symptoms can't be managed at home. Washington's Medicaid rule says hospice care may be in a client's temporary or permanent place of residence. Medicare covers the hospice services for eligible patients at little or no cost (a copayment of up to $5 per prescription and 5% for inpatient respite care); it does not cover room and board, so the home or facility is paid for the way it was before hospice began. "24-hour hospice" means a team on call around the clock with scheduled visits, not a worker in the house all day and night.
Hospice is not a place. It is care that comes to you, wherever you live, when the goal has changed from curing an illness to comfort. Families choosing between staying home, an adult family home, assisted living, or memory care need to know that hospice can usually be added to any of those settings, and that it does not replace them: someone still has to be there between hospice visits, and the residence is still paid for separately.
Own home (yes; family keeps paying for the home, personal care between visits is family or hired caregivers). Adult family home (yes; the resident, Medicaid, long-term care insurance or VA benefits keep paying the home's rate; the hospice team visits). Assisted living or memory care (yes; community staff continue daily care). Nursing facility (yes; coverage interacts with Medicare and Medicaid). Hospice care center or hospital (short-term inpatient and respite stays arranged by the hospice, covered by Medicare).
Medicare Part A covers the hospice benefit for a beneficiary certified as terminally ill (six months or less) who elects comfort care: the team's visits, symptom-control medications, related equipment and supplies, short-term inpatient and respite care. Patient cost is limited to up to $5 per prescription and 5% of the approved amount for respite care. Medicare does not cover room and board at home, in a nursing home, or in a hospice inpatient facility. Washington Medicaid (WAC 388-551) covers hospice for eligible clients; a Medicaid resident of an adult family home keeps their residential coverage.
Washington's Medicaid rule describes hospice as a twenty-four-hour program coordinated by an interdisciplinary team: reachable around the clock, with intermittent scheduled visits. Continuous care is a short-crisis level only. Day-to-day supervision still comes from family, private caregivers, or the staff of the adult family home or facility.
Adult family homes fit hospice well: up to six residents, caregivers present around the clock, accessible rooms. Ask a provider which hospice agencies they work with, whether they have cared for residents through end of life, how they handle hospice-supplied medications, and what changes their rate near the end.
Usually not. In Washington, hospice is delivered by a licensed in-home services agency to wherever the person already lives. Free-standing hospice care centers exist for short stays when symptoms can't be managed at home.
Yes, under Part A for a beneficiary certified as terminally ill who elects comfort care. Out-of-pocket is limited to a copayment of up to $5 per prescription and 5% of the Medicare-approved amount for inpatient respite care.
Room and board. A resident of an adult family home or assisted living on hospice still pays the home's monthly rate, or continues under Medicaid or other coverage. Hospice pays for the hospice; the residence is separate.
No. It means the hospice team is on call around the clock and visits on a schedule. Continuous care exists only for short crises. Daily supervision and personal care still come from family, private caregivers, or the home's staff.
Most can, and many do. Ask which hospice agencies the provider works with and whether they have cared for residents through end of life before.
About the author: David Stein is a Washington State licensed real estate broker (eXp Realty, license #133972) and a Washington State certified residential appraiser (Stein Appraisal, license #1702080), with more than 20 years of experience in both disciplines. More about David.
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