Hospice in Assisted Living — How It Works in Florida

In this article

1. What Florida law actually requires
2. Who does what
3. What Medicare pays and what it does not
4. Getting on hospice
5. Questions worth asking before you sign
6. Why staying put usually matters

Yes. In Florida, a resident who elects hospice can stay in their assisted living apartment and receive hospice care there. State law says so directly: an assisted living facility may admit or keep a resident who is receiving hospice services, as long as the facility and the resident agree to the arrangement, a licensed hospice provides the additional care, and the resident's physician agrees their physical needs can be met at the facility.

Families usually ask this question at a hard moment, and they are often braced for the wrong answer. The common fear is that a hospice election forces another move, to a nursing home or an inpatient hospice unit, in the last weeks of a parent's life. Under Florida law it usually does not.

What Florida law actually requires

The rule lives in Florida Statutes section 429.26, the section that governs who an assisted living facility may admit and keep. Four things have to be true for a resident to stay in place on hospice:

1. The facility and the resident agree to the arrangement
2. The additional care comes from a licensed hospice
3. The resident is under the care of a physician who agrees the facility can meet their physical needs
4. There is a plan of care spelling out how the facility and the hospice will each meet the resident's scheduled and unscheduled needs, including staffing for nursing care if that applies

That fourth item is the one worth reading twice. It is not a formality. It is the document that decides who gives the medication at two in the morning, who calls whom when breathing changes, and who is responsible for what on a Sunday.

There is a second provision families rarely hear about. Florida generally does not allow an assisted living facility to keep a resident who has become bedridden for more than a short stretch, seven consecutive days at a standard community. Residents receiving hospice services are written out of that limit. That exception is precisely what makes staying in place possible as a parent weakens.

Who does what

The most common misunderstanding is that hospice takes over. It does not. Hospice is added to the care your parent already receives, and the two teams work from the same plan.

The practical effect is more attention, not less. A resident on hospice keeps the caregivers who already know how they take their coffee, and gains a nurse who visits regularly, an aide for extra bathing help, a social worker, a chaplain, and a phone line answered at any hour.

What Medicare pays and what it does not

Medicare's hospice benefit is generous about the care and silent about the housing. Under Original Medicare, once a person elects hospice, Medicare covers the services related to the terminal illness: doctor and nursing care, a hospice aide, medical equipment like a hospital bed or oxygen, supplies, prescription drugs for pain and symptom control, physical and occupational therapy, social work, dietary counseling, and grief counseling for the family. There is no deductible. The costs a family still sees are small: up to five dollars per prescription for outpatient comfort drugs, and five percent of the approved amount for an inpatient respite stay.

What Medicare does not pay is room and board. If your parent lives in assisted living, the monthly residency fee is still owed exactly as it was before. The hospice election changes the care, not the rent. This is the same line Medicare draws everywhere else, and we walk through it in more detail in our piece on whether Medicare pays for assisted living.

Florida Medicaid is the pathway that helps with the residency side for those who qualify. Both of our communities accept Florida Medicaid, and a hospice election does not change that.

Getting on hospice

Hospice is elected, not assigned. Under Medicare, two doctors, the hospice physician and the resident's own doctor, certify that the person is terminally ill with a life expectancy of six months or less if the illness runs its normal course. The resident signs a statement choosing comfort care rather than treatment aimed at curing that illness. Florida law adds that admission depends on the expressed request and informed consent of the patient.

Two things families find reassuring:

The six month figure is a prognosis, not a deadline. If a person lives longer, hospice continues as long as a hospice doctor recertifies the terminal illness. Care runs in benefit periods, two of ninety days and then an unlimited number of sixty day periods.

The decision is reversible. A resident can stop hospice at any time and return to treatment, and can elect hospice again later if they become eligible. People do this, and it is not a failure.

Questions worth asking before you sign

If you are choosing a hospice provider for a parent already living in assisted living, the choice is yours, not the community's. A few questions separate providers:

• How often will a nurse visit here, and does that change as needs change?
• Who answers the phone at night, and how long until someone is standing in the apartment?
• Who writes the shared plan of care with the community, and when do we see it?
• Which supplies and equipment do you deliver, and what do we buy?
• How does the hospice aide's schedule fit with the caregivers already helping in the morning?

Ask the community the matching questions. How many hospice patients has the team supported? Who at the community coordinates with the hospice nurse? What happens if a family member wants to stay overnight?

Why staying put usually matters

The last months are not the time to learn a new hallway. A resident who has been at Sugarmill Manor or The Gardens for two years knows the staff, has a chair they like, and has neighbors who notice when they miss lunch. Moving to unfamiliar surroundings at that stage costs something real, and Florida law is written so that it usually is not necessary.

For families who are earlier in this, our pages on assisted living and memory care explain what each level includes. If a parent is coming out of a hospital stay and you are not sure which direction to go, call us and we will talk it through, whether or not you end up here.

This article is general information about how Florida law and Medicare work. It is not medical or legal advice for your family's situation. Talk with your parent's physician about whether hospice is appropriate, and with a hospice provider about what they offer.

Frequently asked questions

Can my mother stay in assisted living if she goes on hospice in Florida?

Usually yes. Florida Statutes section 429.26 lets an assisted living facility keep a resident who is receiving hospice services, as long as the facility and the resident agree, a licensed hospice provides the extra care, and her physician agrees the facility can meet her physical needs. A shared plan of care sets out who does what.

Does Medicare pay for assisted living if my parent is on hospice?

No. Medicare's hospice benefit pays for the hospice care, including nursing, an aide, equipment, supplies, and comfort medications, but it does not pay room and board. The monthly assisted living fee is still owed. Florida Medicaid is the pathway that helps with the residency cost for those who qualify.

Does hospice replace the assisted living caregivers?

No. Hospice is added on top of the care your parent already gets. The community keeps providing housing, meals, and daily help, and the hospice adds a nurse, an aide, a social worker, a chaplain, and a doctor and nurse reachable 24 hours a day.

What happens if my parent becomes bedridden in assisted living?

Florida normally limits how long a resident may stay while bedridden, seven consecutive days at a standard community. Residents receiving hospice services are exempt from that limit, which is what allows a parent to remain in their apartment as they weaken.

Can someone stop hospice and go back to treatment?

Yes. Electing hospice is reversible. A resident can stop hospice at any time, return to treatment aimed at curing the illness, and elect hospice again later if they become eligible.

Sources

• Florida Statutes 429.26: appropriateness of placements in assisted living facilities
• Florida Statutes 400.6095: hospice patient admission, assessment, and plan of care
• Medicare Hospice Benefits (official booklet)
• Medicare: hospice care coverage
• Florida AHCA: assisted living facility licensing

CH

Written by

Cameron Hernando Clark

Community Relations Director

Cameron Hernando Clark is the Community Relations Director for The Manors of Citrus. He writes this family guide to help Citrus County families make sense of assisted living and memory care, drawing on the day to day of running two family owned communities on Florida's Nature Coast.