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Hospice Care in Nursing Homes and the Medicare Hospice Benefit

If your loved one lives in a nursing home and is nearing the end of life, hospice can come to them. The Medicare Hospice Benefit covers nearly all costs for comfort-focused care, including nursing, medications, medical equipment, and bereavement support. This article explains exactly how hospice works in a nursing home setting, what Medicare pays for, and the concrete steps you can take to get this support started.

Key points

  • Hospice brings extra care to nursing home residents without replacing the facility’s staff.
  • Medicare Part A covers 100% of hospice services with no co-pay for eligible patients.
  • Nursing home room and board are paid separately, usually by Medicaid or private funds.
  • Hospice provides 24/7 nurse access, regular visits, medications, equipment, and bereavement support.
  • Bereavement services continue for up to a year after the patient’s death, supporting family and staff.
  • You can choose a different hospice provider if the care is not meeting your loved one’s needs.

What hospice is and why it matters in a nursing home

Hospice is a specialized type of palliative care focused on comfort, dignity, and quality of life when a cure is no longer possible. Unlike regular nursing home care, which may still aim to treat or reverse illness, hospice shifts the goal entirely to symptom management and emotional support for both the patient and the family. For a nursing home resident, hospice does not replace the nursing home staff; instead, a separate hospice team comes in to provide extra services that go beyond what the facility normally offers. This team includes a doctor, nurse, social worker, chaplain, nursing aides, and trained volunteers who work together to address physical, emotional, and spiritual needs.

How the Medicare Hospice Benefit works for nursing home residents

The Medicare Hospice Benefit is part of Medicare Part A and covers 100% of hospice services with no co-pay or deductible for eligible patients. To qualify, a doctor must certify that the patient has a life expectancy of six months or less if the illness runs its normal course. For dementia, this often means the person has reached a very advanced stage, such as being unable to walk, speak, or eat without assistance. Once enrolled, Medicare pays for all hospice-related care, including nursing visits, medications for symptom control, medical equipment like hospital beds and oxygen, and even short-term inpatient care if symptoms become hard to manage. Importantly, the nursing home room and board are still paid separately, usually by Medicaid or private funds, but the hospice services themselves are fully covered.

What hospice adds to the nursing home setting

In a nursing home, the hospice team works alongside the facility’s staff to provide an extra layer of support. A hospice nurse typically visits two to five times per week, and a nursing aide may come several times a week to help with bathing and personal care. The hospice team also offers 24/7 phone access for any questions or emergencies. One major benefit is bereavement services: after the patient passes, hospice provides grief counseling and support groups for family members and even for nursing home staff and other residents who have grown attached to the dying person. These services continue for up to a year after death, helping everyone cope with the loss.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Step-by-step

  1. Step 1: Confirm eligibility with your loved one’s doctor. Ask the nursing home’s medical director or the primary care physician to evaluate whether the resident meets Medicare’s hospice criteria: a prognosis of six months or less if the disease runs its normal course. For dementia, this usually means the person is in the late stage, unable to walk, talk, or eat, and has had significant weight loss or infections.

  2. Step 2: Choose a Medicare-certified hospice provider. Contact your local hospice programs and ask if they are Medicare-certified. You can find a list through the National Hospice and Palliative Care Organization’s online directory or by asking the nursing home’s social worker. Make sure the hospice has experience working in nursing homes and can coordinate with the facility’s staff.

  3. Step 3: Arrange a meeting with the hospice team and the nursing home. Once you select a hospice, schedule a care conference that includes you, the nursing home’s director of nursing, the hospice nurse, and the social worker. Discuss the plan of care, including how often the hospice nurse will visit, what medications will be provided, and how the hospice aides will help with bathing and personal care.

  4. Step 4: Sign the hospice election form. Medicare requires you to sign a statement that you understand you are choosing hospice care instead of curative treatment for the terminal illness. This does not mean you give up all medical care—you can still receive treatment for other conditions, like a urinary tract infection, but you agree to focus on comfort for the terminal diagnosis.

  5. Step 5: Notify the nursing home staff about the change. Tell the nursing home’s charge nurse and the certified nursing assistants (CNAs) that hospice is now involved. Give them the hospice’s 24/7 contact number and explain that the hospice team will be handling symptom management and extra personal care.

  6. Step 6: Prepare for the hospice team’s visits. Make sure the resident’s room has a list of current medications, any advance directives, and a comfortable chair for visitors. The hospice nurse will bring in any needed equipment, such as a hospital bed, oxygen concentrator, or a shower chair. Ask the nurse to show you how to use any new equipment.

  7. Step 7: Use the 24/7 on-call nurse for any concerns. If you notice new symptoms like pain, restlessness, or breathing changes, call the hospice nurse immediately. They can give you instructions over the phone or come to the nursing home to assess the resident. Do not wait until the next scheduled visit.

  8. Step 8: Request bereavement services for yourself and the nursing home staff. After the resident passes, ask the hospice social worker about grief counseling, support groups, or follow-up calls. The hospice can also offer a memorial service or a visit to the nursing home to help other residents and staff process the loss.

  9. Step 9: Keep a notebook of questions and observations. Write down any changes in the resident’s condition, symptoms, or medication needs. Bring this list to each hospice visit so you can discuss it with the nurse. This helps the team adjust the care plan quickly.

  10. Step 10: Review the care plan regularly. The hospice team will update the plan of care at least every two weeks. You can request a care conference at any time if you feel the resident’s needs are not being met. The goal is to keep the person comfortable and pain-free.

What not to do

  • Do not assume hospice means giving up all medical care. Many families worry that hospice means no treatment at all. In reality, hospice provides medications, oxygen, and other treatments to manage symptoms. You can still treat infections or other conditions if they are not related to the terminal illness. Discuss with your clinician what treatments are appropriate.

  • Do not wait until the very last days to start hospice. Some families delay hospice because they think it means death is imminent. But hospice can provide weeks or months of comfort and support. If your loved one is declining and meets the criteria, starting hospice earlier can improve quality of life for everyone.

  • Do not forget that the nursing home still provides room and board. Medicare does not pay for the nursing home’s daily room and board costs. If the resident is on Medicaid, Medicaid usually covers that. If not, you may need to pay privately. Check with the nursing home’s billing office to understand the costs.

  • Do not assume the nursing home staff will handle all hospice tasks. The hospice team is separate from the nursing home staff. The nursing home continues to provide meals, laundry, and general supervision, but the hospice team handles symptom management, extra personal care, and emotional support. Make sure both teams communicate regularly.

  • Do not ignore the bereavement services for yourself. Caregivers often focus entirely on the patient and forget their own grief. Hospice offers counseling and support groups for family members for up to a year after the death. Take advantage of these services—they can help you process the loss and reduce the risk of complicated grief.

  • Do not be afraid to switch hospice providers if the care is not working. If the hospice team is not responsive, not communicating with the nursing home, or not meeting the resident’s needs, you have the right to choose a different Medicare-certified hospice. Talk to the nursing home social worker or your doctor for recommendations.

Practical tools

  • Medicare Hospice Benefit checklist

    A simple checklist to confirm coverage: (1) Doctor certifies six-month prognosis, (2) Patient signs election form, (3) Hospice is Medicare-certified, (4) Nursing home room and board are paid separately (usually by Medicaid), (5) All hospice services—nursing, aides, medications, equipment, counseling—are covered at 100% with no co-pay.

  • The 24/7 on-call nurse number

    Write the hospice’s 24-hour nurse line on a card and tape it to the resident’s bedside table or the nursing home room door. Also give a copy to the nursing home’s charge nurse. This ensures that any symptom change can be addressed immediately, day or night.

  • Symptom tracking log

    Keep a daily log of the resident’s pain level (0-10 scale), breathing, restlessness, and any new symptoms. Note what medications were given and at what time. Bring this log to each hospice visit. This helps the nurse adjust the care plan quickly and accurately.

  • Bereavement support contact list

    Ask the hospice social worker for a list of grief counseling resources, support groups, and follow-up call schedules. Keep this list in a safe place. After the resident passes, use it to schedule a counseling session or join a support group. Many hospices offer these services for free for a year.

  • Care conference agenda template

    Before each care conference, write down three questions or concerns. For example: (1) Is the pain medication working? (2) How often will the aide come this week? (3) Can we add a volunteer visit? Bring this list to the meeting to ensure all your concerns are addressed.

  • Phrases to say to the nursing home staff

    When introducing hospice to the nursing home staff, say: 'Hospice is here to help us all. They will handle symptom management and extra personal care. Please call them at [number] if you see any changes in [resident’s name].' This clarifies roles and reduces confusion.

Discuss with your clinician

Ask the doctor: 'Is my loved one eligible for hospice now, or should we wait until certain symptoms appear?'

Ask the hospice nurse: 'What medications will be used for pain and agitation, and what are the side effects?'

Ask the nursing home medical director: 'How will the nursing home staff coordinate with the hospice team for daily care?'

Ask the hospice social worker: 'What bereavement services are available for me and for the nursing home staff?'

Ask the hospice doctor: 'Can we continue treating infections or other conditions while on hospice?'

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