Can You Get Hospice in a Group Home or Board and Care Home?

Yes. You can get hospice in a group home or a board and care home. Medicare hospice is provided wherever the person lives, not only in a private house or a nursing home. The hospice team comes to the home and brings the nursing, symptom control, medications and equipment that these small homes usually do not provide. What hospice does not pay is the home's monthly charge for the room, meals and daily help, which stays the resident's responsibility.

What counts as a board and care or group home

The National Institute on Aging describes board and care homes, also called residential care facilities or group homes, as small private facilities, usually with 20 or fewer residents. Residents get personal care and meals, and staff are available around the clock. Nursing and medical care usually are not provided at the home. Names and licensing differ from state to state, so the home your family is using may go by another name.

That gap is where hospice fits. Medicare.gov says you can usually get hospice "in your home or other facility where you live." CMS's hospice billing codes reflect the same idea, with separate site codes for a private residence, an assisted living facility, nursing facilities, hospitals and a "place not otherwise specified." Hospice is designed to reach people where they live.

Who pays for what

Cost	Who typically pays
Hospice nurse, aide, social worker, chaplain and on-call line	Medicare hospice benefit
Comfort medications for the terminal illness	Medicare hospice benefit (copay of up to $5 per prescription)
Equipment and supplies for the terminal illness	Medicare hospice benefit
The home's monthly fee: room, meals, daily personal care	The resident, from income, savings, long-term care insurance or other help

Medicare does not cover room and board when you get hospice care where you live, and the NIA says Medicare does not cover the costs of living at a board and care home. Medicaid may pay part of the cost in some states, depending on the state and whether the person is eligible. Even then, federal Medicaid funding for home and community-based waiver services generally cannot be used for room and board (42 CFR 441.310), so the rent-and-meals part usually stays with the resident. For the same rule in other settings, see does hospice cover room and board, setting by setting.

How the home's staff and the hospice team share the work

The home's caregivers keep doing what they did before: meals, help with bathing and dressing, supervision, and being there day and night. The hospice adds:

• Nurse visits to manage pain, breathlessness and other symptoms
• Hospice aide visits for personal care, which are scheduled, not continuous
• Comfort medications and clear instructions for the home's staff
• Equipment such as a wheelchair or walker when the plan of care calls for it
• A nurse and doctor on call 24 hours a day
• Social work, chaplain and grief support for the resident and the family

Hospice does not replace the home's staff or supply a caregiver to sit with the resident around the clock. Aide time is limited, as explained in how many hours of aide care hospice provides.

Group homes for people with intellectual or developmental disabilities

Some group homes are certified as intermediate care facilities for individuals with intellectual disabilities (ICF/IID). The hospice rules treat these like nursing homes. Under 42 CFR 418.112, the hospice and the ICF/IID must have a signed written agreement before hospice care starts. The facility stays responsible for 24-hour room and board care at the same level it gave before hospice, and it must notify the hospice right away about significant changes, a needed transfer, or a death. If your family member has both Medicare and Medicaid and Medicaid pays for the ICF/IID care, federal law has the state Medicaid program pay the hospice for room and board once hospice starts, and the hospice usually pays the facility. If your family member lives in this kind of home, ask whether the home already has an agreement with a hospice.

Questions that decide whether it works

Hospice rules do not require anyone to move out of a group home. Whether a resident can stay as needs increase is up to the home, its license and its staffing. Ask the home early:

• Can you keep a resident who becomes bed-bound or needs two people to help with transfers?
• Can your staff give the comfort medications the hospice prescribes, and who handles doses overnight?
• Have you worked with hospices before, and which ones?
• Will your monthly rate change as care needs rise?

Then ask the hospice how it will communicate with the home's staff, especially at night, and how often its nurse and aide will visit.

Frequently asked questions

Does starting hospice mean leaving the group home?

No. Hospice comes to the resident. Whether the home can keep caring for the resident as the illness advances is a separate question that the home and its license decide.

Will hospice pay the group home's monthly fee?

No. Hospice pays for care related to the terminal illness, not for the room, meals or daily personal care the home provides. That charge continues as before.

Can Medicaid help with the bill?

Sometimes, depending on the state and the person's eligibility. Medicaid programs may help pay for services in some residential settings, but federal waiver funds generally do not cover room and board. The hospice social worker can explain your state's options; see also financial help for hospice families.

Is this the same as hospice in assisted living?

The payment rule is the same: hospice care is covered, the residence's fee is not. Assisted living communities are often larger and offer more services, and their contracts and state rules differ.

Your practical next step

Call the group home and the hospice together and confirm three things: the home can keep your loved one as care needs grow, the home's staff and the hospice know who handles medications and night calls, and the monthly fee is clear in writing. If you have not chosen a hospice yet, compare hospices near you and ask each one whether it already serves residents of small care homes in your area.