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 one thing before anything else: hospice can usually be added to any of those, and it does not replace them.
Quick Answer
Where can my parent receive hospice care in Washington?
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. Medicare covers the hospice services for eligible patients at little or no cost; it does not cover room and board, so the home or facility is paid for the way it was before. "24-hour hospice" means a team on call around the clock with scheduled visits, not a worker in the house all day and night.
What hospice is, and what it isn't
Hospice is a coordinated program of medical, nursing, personal, emotional, and spiritual support for someone whose illness is no longer being treated for cure. In Washington it is delivered by an in-home services agency licensed by the Department of Health under chapter 246-335 WAC, and it is built around an interdisciplinary team: a hospice physician, nurses, aides, a social worker, a chaplain, and volunteers.
What it is not: a building you move into, a replacement for the people who care for someone day to day, or a way to make the cost of a residence disappear. Each of those misunderstandings shows up in family conversations every week, so the rest of this guide takes them one at a time.
Where hospice can come
Washington's Medicaid rule (WAC 182-551-1000) states it plainly: hospice care may be in a client's temporary or permanent place of residence. Medicare says the same. The table below is the practical version.
Own home
Hospice can come there? Yes
Who generally pays for the residence: Nobody extra: the family keeps paying for the home as before. Personal care between hospice visits is family, private caregivers, or in-home care.
Adult family home
Hospice can come there? Yes
Who generally pays for the residence: The resident (private pay), Medicaid, long-term care insurance, or VA benefits, exactly as before hospice began. The hospice agency's team visits the home.
Assisted living or memory care
Hospice can come there? Yes
Who generally pays for the residence: The resident or their existing coverage. The community's staff continue daily care; hospice adds to it.
Nursing facility
Hospice can come there? Yes
Who generally pays for the residence: Medicare hospice does not pay nursing-home room and board. The resident pays privately, or long-term care insurance or Apple Health (Medicaid, for eligible residents) pays it.
Hospice care center or hospital
Hospice can come there? Yes, short term
Who generally pays for the residence: Medicare covers qualifying short-term inpatient care and respite stays arranged by the hospice; these are not long-term residences.
| Where they live | Hospice can come there? | Who generally pays for the residence |
|---|---|---|
| Own home | Yes | Nobody extra: the family keeps paying for the home as before. Personal care between hospice visits is family, private caregivers, or in-home care. |
| Adult family home | Yes | The resident (private pay), Medicaid, long-term care insurance, or VA benefits, exactly as before hospice began. The hospice agency's team visits the home. |
| Assisted living or memory care | Yes | The resident or their existing coverage. The community's staff continue daily care; hospice adds to it. |
| Nursing facility | Yes | Medicare hospice does not pay nursing-home room and board. The resident pays privately, or long-term care insurance or Apple Health (Medicaid, for eligible residents) pays it. |
| Hospice care center or hospital | Yes, short term | Medicare covers qualifying short-term inpatient care and respite stays arranged by the hospice; these are not long-term residences. |
Who pays for what
Medicare pays for the hospice
For a Medicare beneficiary, hospice is covered under Part A once a physician certifies a terminal illness with a life expectancy of six months or less and the patient elects comfort care in place of curative treatment. The benefit covers the hospice team's visits, medications for pain and symptom control, medical equipment and supplies related to the terminal illness, short-term inpatient care, and respite care the hospice arranges. The benefit runs in two 90-day benefit periods, followed by an unlimited number of 60-day periods, as long as the hospice doctor recertifies that the patient is terminally ill. According to Medicare's own guidance, the patient pays nothing for covered hospice services except a copayment of up to $5 per prescription for symptom-management drugs and 5% of the Medicare-approved amount for inpatient respite care. Original Medicare keeps covering health problems unrelated to the terminal illness.
Medicare does not pay for the residence
Medicare states that it does not cover room and board when hospice is received at home, in a nursing home, or in a hospice inpatient facility. This is the sentence families most need. If Mom lives in an adult family home at $7,000 a month and goes on hospice, the home still costs $7,000 a month. Hospice does not lower it, and it does not become "free care." What changes is that a nurse, an aide, a social worker, and a chaplain now come to the home, and the medications and equipment for her comfort are supplied by the hospice at no charge.
Medicaid (Apple Health)
Washington's Apple Health (Medicaid) hospice program is run by the Health Care Authority under chapter 182-551 WAC. For a resident who has Medicare, Medicare Part A pays for hospice; Apple Health covers hospice only for people without Medicare. A Medicaid resident of an adult family home who elects hospice keeps their residential coverage: the home continues to be paid its DSHS daily rate for the resident's care level, and the hospice agency bills Medicare (or Apple Health, if the resident has no Medicare) for the hospice services. Nothing about the placement has to change.
What "24-hour hospice" actually means
Washington's Medicaid rule (WAC 182-551-1000) describes hospice as a 24-hour-a-day program, with care coordinated by a hospice interdisciplinary team. Read that carefully: the program is available around the clock, meaning a nurse is reachable at 3 a.m. and will come if needed. It does not mean a hospice worker stays in the home. Routine hospice care is intermittent: scheduled visits, typically several a week, of varying length. Continuous around-the-clock care exists as a distinct level for short crises, and it ends when the crisis does.
The practical consequence is the one families underestimate. Someone still has to be there for the hours between visits: to help with the bathroom, meals, turning, medications at the right time, and the night. At home that is family or hired caregivers. In an adult family home or assisted living it is the staff who were already caring for the resident, which is exactly why hospice layers so well onto those settings rather than replacing them.
Hospice inside an adult family home
Adult family homes are, by design, a good fit for hospice: a household of two to six residents (up to eight with DSHS approval) and caregivers present around the clock. Many homes in Washington care for hospice residents; ask each provider about their experience. The hospice agency's team visits the home, coordinates with the provider on medications and the plan of care, and supplies the equipment.
Questions worth asking a provider before placing a parent who is, or may soon be, on hospice:
- Which hospice agencies have you worked with, and can I speak with one of them?
- Have you cared for residents through the end of life in this home before?
- How do you handle medications the hospice supplies, including comfort medications at night?
- What does your rate cover if care needs rise near the end, and what would change it?
- How do you support the family during and after?
Every licensed home in the state is in the AFH Club directory, by city and county, with capacity, specialty designations, and Medicaid status. For what a home costs in a given place, the cost-by-location lookup shows the Medicaid rate range and licensed-home counts for any Washington city or county.
Hospice versus palliative care
Palliative care is comfort-focused care that can run alongside curative treatment at any stage of a serious illness. Hospice is palliative care for someone who has chosen comfort in place of cure, with a prognosis of six months or less. A person can receive palliative care for years; hospice is elected when treatment aimed at cure has stopped. Both can be delivered in the same settings.
How to start
- Ask the treating physician whether hospice is appropriate; a physician's certification is required.
- Choose a Medicare-certified hospice agency. If your parent lives in an adult family home or facility, ask which agencies already serve it.
- Confirm the residence arrangement stays as it is: same room, same rate, same payer.
- Ask the hospice for its visit schedule and its after-hours number, and put both where every family member can find them.
Sources: Medicare.gov, "Hospice care" coverage page; CMS hospice payment guidance (FY2026); chapter 182-551 WAC (Washington Apple Health hospice program, Health Care Authority); RCW 70.128.010 (adult family home capacity); chapter 246-335 WAC (in-home services agencies and hospice care centers); RCW 70.127. Rules and copayment amounts change; confirm current figures with Medicare and the hospice agency. This guide is educational and is not medical, legal, or financial advice.