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What is Hospice Care in a Nursing Home?

Hospice care within a nursing home provides terminally ill patients and their families with extra layers of support. Hospice care includes expert management of pain and other symptoms, spiritual counseling, care planning, and grief support.

Hospice services provided in a nursing facility are covered by Medicare benefits. The hospice benefit includes resources and support for family and loved ones. Medicare hospice benefits do not cover room and board expenses.

In a Nursing home, staff have specialized training in custodial care, while hospice staff are experts at end-of-life care. Custodial care focuses on the activities of daily living, such as eating, bathing, and maintaining the quality of life. Meanwhile, hospice is comfort care to reduce the stress, pain, and other symptoms of a terminal illness.

It is about helping patients and their families live as well as they can when life expectancy is limited. A good number of people assume that if you are receiving care in a nursing home or residential facility you do not need or cannot access hospice care at the end of life.

Hospice is a program that provides care wherever clients live; it is not a place. Individuals can receive care at their place of residence; including their private home, nursing home, residential facility, or hospice inpatient facility.

Also, people are afraid to lose their nursing home caregivers by enrolling in hospice care. If you live at a nursing home or assisted living facility, the hospice team will align with the staff there to provide additional services. Your Hospice team will coordinate your care with any other care providers you have and will not replace caregivers that you currently have relationships with.

Have it in mind there are many benefits to hospice care that will complement and add to the care you may receive at a nursing home.

Most importantly, you will gain from the hospice team’s expertise on end-of-life issues and concerns. Note that the team will provide education and support around what to expect in the dying process and provide comfort measures for both clients and families.

Note that hospice care needs can vary for each patient and their loved ones. Every situation is unique. It is not unusual for doctors to hold off on a recommendation for this caregiving approach until someone is already close to death, which means they miss out on the many benefits that are possible with this form of care.

Indeed, there are many misconceptions about hospice care that many people still believe all over the world. Some of these problems have to do with a general lack of awareness about the services and benefits that are available with this caregiving option.

That entails that some people fail to enter hospice care at all, leading to high under-utilization rates in many communities. Although end-of-life care may be daunting and heavy to discuss, it is ideal for you to discuss your wishes before you and your family are in crisis.

Furthermore, hospice care is most beneficial when started as early as possible affording adequate time for symptom and pain management and the development of trusting relationships between patient, family, and hospice team.

Benefits of Hospice in Nursing Home Settings

In a nursing home setting, hospice helps patients, families, and nursing home staff by providing:

  • Steady visits by a hospice Registered Nurse to the nursing home.
  • Consultations by a specialized hospice physician as needed.
  • Expert management of pain and other symptoms, such as problems breathing or swallowing.
  • Education for nursing home staff, patients, and families about patients’ condition, symptoms, medications, and how to best care for patient’s medical needs during this phase of their illness.
  • Emotional and spiritual support for both the patient and their family during this phase of life. This includes help for the family before and after the patient dies.
  • Offer medications and supplies related to the patient’s terminal illness
  • Coordinating the patient’s care and medications across all of the patient’s medical providers, including the patient’s own doctors, hospice doctors, hospice nurses, hospice aides, and all nursing home staff.

Duties of a Nursing Home during Hospice

The nursing home is responsible for:

  • Communicating and coordinating patient care with the hospice.
  • Monitoring the patient’s condition and reporting any changes to the hospice.
  • The routine daily care for patients at the nursing home.
  • Normally scheduled medical care and examinations by the attending physician and medical director.
  • Providing medications and supplies for care not related to the patient’s terminal illness.
  • Keep in mind that hospice benefits do not usually cover the cost of housing a patient in a nursing home or assisted living facility (also known as daily room and board costs). However, these costs may be covered by traditional Medicare benefits or other benefits you have.

Hospice Eligibility Criteria for Patients in a Nursing Home

Patients in a nursing home or skilled nursing facility are eligible for the Medicare hospice benefit if they meet these criteria.

  • A doctor and a hospice medical director certify the patient has a terminal illness, meaning a life expectancy of six months or less
  • The patient signs a statement electing hospice care and waiving treatments for the terminal illness. Patients still receive treatment and care for other medical conditions
  • The nursing facility has a contract with a Medicare-certified hospice provider.
  • Patients may stop hospice and re-start medical treatments at any time


Hospice has the goal of improving the quality of the care received instead of prolonging a person’s life during the last phases of an incurable disease. The philosophy of hospice care is that it accepts death as the final stage of this life. It affirms the existence of each person without trying to postpone or hasten the expected terminal outcome.

For some patients with a terminal illness, their “home” is in a nursing home. A hospice may have contracts with some nursing homes in their vicinity to provide hospice care for patients in the nursing home. If you are interested in hospice care in a nursing home, ask your local nursing home which hospices they work with.