Hospice in a nursing home: Who pays what?

By Grace Blanchard RN, CHPN

Hospice is a benefit of Medicare Part A. All services provided by hospice are covered at 100%. Nearly 98% of hospice patients live at “home;” which could be a house, apartment, assisted living, or extended care facility. Hospice services include RN visits, home health aide visits, chaplain visits, social worker visits, volunteer visits, durable medical equipment, and meds associated with comfort for the terminal illness.

Nobody ever asks if hospice is going to pay their rent or mortgage, but the question of who pays room and board at a nursing home comes up almost daily in my hospice conversations. The answer often confuses and angers families.

Many times, a patient has been using skilled Medicare days at a nursing home and so Medicare has been paying part of room and board. Most families understand that when those skilled days are used up, room and board will be either private pay or paid by Medicaid, if the resident qualifies. This concept is harder to grasp for patients who are going into a facility for the first time. They may expect Medicare to pay for room and board as part of the hospice benefit, and they are disappointed when they learn hospice doesn’t include 24-hour caregivers at home or in a facility.

Many people also have a hard time accepting that Medicare will not pay for skilled days and hospice care at the same time. Medicare considers these services different plans of care, so for the patient and family, it’s an either/or decision. Families can have both these services, if they are willing to privately pay for hospice.

Hospice care is meant to be supportive care for patients and family through the dying process. The main focus is comfort and symptom management. It helps sometimes to explain to the family that Medicare skilled days have a different focus, and so the family can make a choice based on their individual needs and desires. For example, if a nursing home resident is doing PT/OT, they will be expected to get up and do that therapy. If they are unable to participate in therapy, or if it’s causing pain or stress, the patient and family may choose to discontinue that plan of care and sign up for hospice. However, at that point, Medicare will stop paying room and board.

 
 
 

About the author

I am passionate about sharing senior citizen news and resources discovered from both my profession and personal journey.

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