Hospice in a care home: what the state actually requires
Many families assume a hospice diagnosis means leaving a care home. California law says the opposite can be true: a terminally ill resident may stay — or even move in — and receive hospice services in the home, when the state’s approval is in place. The approval has a name, the paperwork has an order, and both are worth knowing before the conversation with a home begins.
What approval does the home need?
The state’s own term is “hospice care waiver” — it is the title of the regulation (22 CCR §87632, “Hospice Care Waiver”), granted by the Department of Social Services, not something a home declares for itself. The department’s notice to licensees puts it plainly:
“Important! The licensee must have an approved hospice waiver or an exception from the department when accepting or retaining residents who receive hospice services.”
The waiver is requested from, evaluated by, and granted by the department (§87632(a)–(e)) — the department may deny it, and no request is approved “unless the facility demonstrates the ability to meet the care and supervision needs of terminally ill residents” (§87632(c)). The decision stays with the state at every step.
What must exist before hospice services begin?
A written care plan, agreed by everyone, first. The regulation makes the plan a precondition, not an afterthought:
“A written hospice care plan which specifies the care, services, and necessary medical intervention related to the terminal illness as necessary to supplement the care and supervision provided by the facility is developed for each terminally ill resident or prospective resident by that resident’s hospice agency, and agreed to by the licensee and the resident, or prospective resident, or the resident’s or prospective resident’s Health Care Surrogate Decision Maker, if any, prior to the initiation of hospice services in the facility for that resident, and all hospice care plans are fully implemented by the licensee and by the hospice(s).”
Two more pieces of required paper, both the home’s to handle:
“A written request shall be signed by each terminally ill resident or prospective resident upon admission, or by the resident’s or prospective resident’s health care surrogate decision maker to allow for his or her acceptance or retention in the facility while receiving hospice services.”
“The licensee shall notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or within five working days of admitting a resident already receiving hospice care services.”
The hospice agency itself must be both state-licensed and Medicare-certified, and it is contracted by the resident or their surrogate — individually, never by the home on a resident’s behalf (§87633(a)(3)).
What about health conditions these homes normally cannot accept?
Title 22 lists health conditions that ordinarily may not be accepted or retained in a residential care facility for the elderly (§87615, Prohibited Health Conditions — examples in the regulation’s list include stage 3 and 4 pressure sores, naso-gastric tubes, and tracheotomies). For a terminally ill resident, the hospice pathway can carry those conditions — but by the department’s grant, on the hospice care plan’s terms, never by the home’s own judgment:
“Facilities that have satisfied the requirements of Section 87632, Hospice Care Waiver, are not required to submit written exception requests under this section for residents or prospective residents with restricted health conditions under Section 87612 and/or prohibited health conditions under Section 87615 provided those residents have been diagnosed as terminally ill and are receiving hospice services in accordance with a hospice care plan as required under Section 87633, Hospice Care for Terminally Ill Residents, and the treatment of such restricted and/or prohibited health conditions is specifically addressed in the hospice care plan.”
And even a home that cannot keep someone still owes them help reaching hospice care — the statute assigns an access duty:
“A residential care facility for the elderly that accepts or retains residents with prohibited health conditions, as defined by the department, in Section 87615 of Title 22 of the California Code of Regulations, shall assist residents with accessing home health or hospice services, as indicated in the resident’s current appraisal, to ensure that residents receive medical care as prescribed by the resident’s physician and contained in the resident’s service plan.”
Glossed carefully: that sentence creates a duty to help residents reach care — it is not permission for a home to retain anyone the rules say it cannot.
What are the three questions to ask a home?
- “Do you hold a current hospice care waiver from the department — and for how many residents at a time?” (The waiver names a maximum; §87632(a)(1).)
- “Which hospice agencies have residents here worked with?” (The choice of agency is the resident’s, but experience together matters day to day.)
- “Will the written hospice care plan be agreed — by you, the hospice, and us — before services begin?” (That order is the regulation’s, §87633(a)(4).)
Where does this come from?
Every quoted sentence above is Title 22 of the California Code of Regulations (§§87615, 87616, 87632, 87633), the California Health and Safety Code (§1569.39), or the department’s own Provider Information Notice 22-24-ASC, verbatim — the Title 22 text is published in the state’s official regulation manual. We add the citations and the plain-language notes, and nothing else. Public-record information, not medical or legal advice; the hospice’s own team and the local ombudsman are the right people for a specific situation. For what a home must disclose about retention limits in writing, see what could make me have to leave.