Assisted Living, Hospice Care, and Hospice Care Waiver

The reality is that a decent percentage of women and men who reside in assisted living will benefit from hospice care at the end their lives. Additionally, many of these people may desire or would benefit substantially from being able to access hospice care from the assisted living community in which they have been residing. In other words, people at a stage in which hospice care is appropriate do not want the added strain of having to move to a different location to receive these important services.

In California, an assisted care facility is able to obtain a waiver from the state that permits the community the ability to allow residents the ability to access hospice care from a credentialed provider while still residing in the community. In other words, a person in assisted living will not be required to leave assisted living if a facility has obtained a proper waiver from the state. 

If you are in assisted living, you should familiarize yourself with the basics associated with a hospice waiver. Alternatively, if you have an elderly parent in hospice care, your mother or father’s adult child, it is also wise that you develop a basic understanding of what is involved in an assisted living hospice waiver and in receiving hospice services while remaining a resident of this type of long-term care community. 

Requirements of Assisted Living Community to Obtain Hospice Waiver

In order to obtain an appropriate hospice waiver, an assisted living facility must satisfy four requirements established by the state of California. These requirements are:

  • Advise the state of California of the maximum number of terminally ill residents which the facility wants to make hospice services available. 
  • Provide a statement by the assisted living license holder that he or she has read Hospice Care for Terminally Ill Residents and all other requirements within Chapter 8 of Title 22 of the California Code of Regulations governing Residential Care Facilities for the Elderly and that they will comply with these requirements.
  • Provide a statement by the licensee that the terms and conditions of all hospice care plans which are designated as the responsibility of the licensee, or under the control of the licensee, shall be adhered to by the licensee.
  • Finally, a statement by the licensee that an agreement with the hospice agency will be entered into regarding the care plan for the terminally ill resident to be accepted and/or retained in the facility. The agreement with hospice shall design and provide for the care, services, and necessary medical intervention related to the terminal illness as necessary to supplement the care and supervision provided by the licensee.

Agreement With Hospice Provider

When an assisted living community is granted a hospice waiver, the facility does not experience an expansion in its services. Rather, an assisted living community is able to provide only those services it was permitted before receiving a hospice waiver.

What the waiver does do is permit a resident in need of hospice care to continue to reside in the assisted living community. The waiver also permits an assisted living facility the legal ability to enter into an agreement with a hospice to provide services to residents in need of end of life care, support, and assistance. 

Once a waiver is approved, an assisted living facility must demonstrate that a hospice has agreed to design a plan to provide care, services, and needed medical intervention related to the terminal illness as necessary to supplement the care and supervision provided by the facility. An agreement needs to be executed between the facility and the hospice regarding the care plan for the terminally ill resident or terminally ill person to be accepted as a resident. The care plan shall designate the primary caregiver, identify other caregivers, and outline the tasks the facility is responsible for performing and the approximate frequency with which they shall be performed. 

Specific Elements of an Assisted Living Hospice Care Plan

The hospice care plan developed between a hospice and an assisted living community must be provided to the state of California. An assisted living hospice care plan must include the following elements:

  • Name, office address, business telephone number, and 24-hour emergency telephone number of the hospice agency and the resident’s physician.
  • Description of the services to be provided in the facility by the hospice agency including but not limited to the type and frequency of services to be provided
  • Designation of the resident’s primary contact person at the hospice agency, and resident’s primary and alternate care giver at the facility
  • Description of the area of licensee’s responsibility for implementing the plan including, but not limited to:
  • Facility staff duties
  • Record keeping
  • Communication with the hospice agency
  • Communication with resident’s physician
  • Communication with resident’s responsible person if any
  • Frequency of the tasks to be performed by the facility
  • Description of all hospice services to be provided or arranged in the facility by persons other than the licensee, facility personnel, or the hospice agency including, but not limited to, clergy and the resident’s family members and friends
  • Identification of the training needed, which staff members need training, and who will provide the training relating to the licensee’s responsibilities for implementation of the hospice care plan
  • Any other information deemed necessary to ensure that the terminally ill resident’s needs for health care, personal care, and supervision are met by the plan

If you are considering assisted living, and if you are thinking ahead to the time when you may need hospice care, you will want to ascertain if a particular facility does have an appropriate hospice waiver. The same holds true for the adult child or an elderly parent considering assisted living.