Can You Bring a Loved One Home From a Nursing Home on Hospice?

Yes. A nursing home resident on hospice can move home, and the hospice benefit goes with them. Medicare hospice is provided wherever the person lives, so leaving the facility does not end it. What changes is who does the hands-on caregiving and who pays for it. At home, the family supplies the day-to-day and overnight care that nursing home staff used to give. Hospice visits, comfort medications and equipment stay covered, but hospice does not provide round-the-clock caregivers.

Hospice follows the patient

Medicare.gov says you can usually get hospice care "in your home or other facility where you live." A move from a nursing home to a house is a change of address, not a new start. If the current hospice serves the new address, the same team can keep caring for your loved one. If it does not, the hospice can arrange a transfer to one that does, much like the process in getting hospice in another state.

The resident also has the right to leave. CMS tells nursing home inspectors that a facility "cannot restrict a resident's right to leave the facility." The nursing home must still plan the discharge with you, as described below.

What changes when care moves home

Cost or service	In the nursing home	At home
Hospice team visits, comfort medications, equipment for the terminal illness	Medicare hospice benefit	Medicare hospice benefit (no change)
Room, meals and 24-hour personal care	Nursing home, paid privately or by Medicaid	The family provides it, or pays for hired help
Medicaid room-and-board payment through the hospice	May apply for eligible residents	Ends, because it pays for the nursing home bed
Inpatient respite for family caregivers	Not available to nursing home residents	Available, up to 5 days at a time

For residents with both Medicare and Medicaid, the Medicare manual says the state Medicaid agency pays the hospice a daily room-and-board amount, and the hospice passes it to the nursing home. That payment covers the nursing home bed, so it stops once your loved one moves out. On the other hand, respite becomes available. Medicare's rules say respite cannot be provided to hospice patients who live in a facility such as a nursing home. At home, a family caregiver who needs a break can get up to 5 days of inpatient respite at a time, with a coinsurance of 5% of the Medicare-approved amount. See what respite care in hospice is.

The honest part: who covers the nights

In the nursing home, staff are there around the clock. At home, hospice aide visits are scheduled and intermittent. A nurse is on call 24 hours a day, but nobody from hospice stays in the house all day and all night as routine care. More intensive care at home is available only during a short-term symptom crisis. Before you move, work out who will be there overnight, on weekends and as care needs grow. The detail is in does hospice pay for 24-hour care or caregivers at home.

Families usually cover the gap in one of these ways:

• Relatives take shifts, with the hospice team teaching them how to give care
• Family members are on hand for some hours and hired private-duty caregivers cover the rest
• Someone moves in temporarily for the final weeks

How the nursing home discharge should work

Federal rules (42 CFR 483.21) require nursing homes to plan discharges with the resident and their representative. The plan must take into account the resident's goals and whether a caregiver is available and able to give the care needed. Use that process. Ask the nursing home's team and the hospice to meet with you before moving day so the plan is realistic.

Leaving is a discharge, not a leave of absence. The federal right to return to the same nursing home applies to residents who go to the hospital or on therapeutic leave. A resident who moves home may not have a bed held. If there is any chance your loved one will need to come back, ask about readmission before you go.

Getting the house ready

Medicare's hospice booklet lists medical equipment (such as wheelchairs and walkers), supplies, and hospice aide and homemaker services among what the benefit covers. Have the hospice order equipment for delivery before your loved one arrives, so nothing is missing on the first night. See what equipment and supplies hospice covers. Also ask:

• Will a hospital bed, commode or oxygen be delivered before the move?
• Are comfort medications filled and ready at the house, with written instructions?
• When is the first nurse visit after arrival?
• How will your loved one get home, and who pays for the ride? Ask before you book it.

Frequently asked questions

Can we bring her home just for the last days?

Yes. Many families make this move near the end. Because the final days often need near-constant presence, plan who will be there before you go, and ask the hospice what support it can give during a symptom crisis.

Will Medicaid pay for anything at home?

The nursing home room-and-board payment stops. Medicaid home and community-based services waivers can pay for some help at home, but each state designs its own waivers, and states can cap how many people a waiver serves. Ask the hospice social worker what your state offers.

Do we have to change hospices?

Not if the current hospice serves your home address. If it does not, the two hospices can coordinate a transfer so care does not lapse.

What if caring for her at home turns out to be too much?

Tell the hospice right away. Options include inpatient respite for a few days, inpatient care if symptoms cannot be controlled at home, and moving to a facility. Remember that a bed at the old nursing home is not guaranteed after a discharge.

Your practical next step

Before you sign anything at the nursing home, sit down with the hospice nurse and social worker. Agree on a move date, equipment delivery, a medication plan and a caregiving schedule that covers every night. If your loved one is not on hospice yet, compare hospices near you that serve your home address.