Hospice Room and Board in a Nursing Home: Who Pays?

At a glance

In short, keep two columns in your mind. Column one is hospice care: the hospice team, comfort care, and related support. Column two is room and board: the bed, the room, meals, and basic daily living in the nursing home. The hospice benefit covers column one. Someone else must cover column two.

What the hospice benefit covers

Hospice is care for a person whose doctor expects a life expectancy of 6 months or less if the illness runs its normal course. That rule is from ledger entry B1. The focus shifts to comfort and quality of life. The hospice team includes nurses, aides, a social worker, and others who support the patient and family.

When a person elects hospice under Medicare, the hospice benefit pays the hospice provider for hospice care. That care can be given in a home, in a nursing home, or in other settings. The place changes. The split between hospice care and room costs stays the same in a nursing home.

What does the patient pay for hospice itself? There is no deductible for hospice. That is from ledger entry A14. The patient may pay up to $5 per outpatient prescription for pain and symptom control. The patient may also pay 5% of the Medicare-approved amount for inpatient respite care. Those are the patient cost shares named in A14.

Respite care is a short stay that gives family caregivers a rest. A respite stay can last up to 5 consecutive days at a time. That limit is from ledger entry A15. Respite is part of the hospice benefit. It is different from living in a nursing home day after day as a resident, which is where room and board charges apply.

If your loved one is at home rather than in a nursing home, the daily picture is different. For that case, read how to plan daily help when hospice is provided at home. At home there is no facility room charge, but family must plan hands-on help in other ways.

Sample situation

Walter Greene lives in a nursing home and now needs hospice care. His daughter, Simone, thought the hospice benefit would pay for everything at the home. At a family meeting, the hospice team explains the split in plain words. Hospice care is one cost. Room and board is a separate cost. The hospice benefit pays for hospice care. It does not pay for room and board in a nursing home. Simone feels caught off guard, but she is glad to learn this before a bill arrives. She asks the nursing home for its room and board rate in writing. She asks what the charge includes and what costs extra. She compares the rate to the national median for a semi-private room, which is $9,581/month, to see the scale of the cost. Then she checks each path for the room. She looks at what Walter can pay from his own funds. She asks about Medicaid for people who qualify. She also finds his long-term care insurance policy and plans to call the insurer for an answer in writing. By naming the two costs out loud and getting the split in writing, Simone can plan the room cost while Walter gets kind hospice care.

What room and board means

Room and board is a facility term. Room means the living space and bed. Board means meals and basic daily services of living in the building. It can also include laundry and housekeeping as the facility defines them. Ask the nursing home to list, in writing, what its room and board charge includes.

Room and board is not medical care. It is not hospice care. It is the cost of living in the facility while care is given there. That is why the hospice benefit does not pay it when the nursing home is the person's residence.

There is one point that confuses families. If a hospice patient needs a short stay for a hospice reason, such as respite care or a higher level of hospice care in a facility, the hospice benefit rules for that stay are different from routine residence. Ask the hospice team to explain, in your loved one's case, which stays are hospice stays and which days are resident days. Get the answer in writing with dates.

Do not rely on a verbal promise about who pays. Ask both the hospice and the nursing home the same question. Compare the answers. If they differ, ask them to talk to each other and give you a joint answer in writing before the stay starts or as soon as you can.

How much nursing home residence can cost

Room and board charges connect to the wider cost of nursing home residence. The CareScout Cost of Care Survey gives national medians that help families plan. For a semi-private room, the median is $315/day, $9,581/month, and $114,975/year. That is ledger entry F5. For a private room, the median is $355/day, $10,798/month, and $129,575/year. That is ledger entry F6.

These are survey medians for planning. They are not a quote from any one nursing home. They are not the hospice benefit's figures. They show the scale of residence costs in a nursing home, so a family can see why the room and board question matters so much.

Your facility's actual room and board charge may be lower or higher than these medians. Ask for the exact daily rate for the room type your loved one will use. Ask what is included. Ask what costs extra. Ask how often rates rise and how much notice you will get.

Also ask how the bill is counted. Is it charged by the day, by the month, or both? What happens on the day of a move in or move out? What happens during a hospital trip? Clear answers now prevent painful disputes later, at a time when the family is already under strain.

The three main paths for paying room and board

The first path is private pay. The resident or family pays the nursing home from income, savings, or other funds. This is the most direct path, but it can use funds fast. Ask how long current funds may last at the stated rate, and plan the next step well before funds run low.

The second path is Medicaid. For people who meet their state's Medicaid rules for long-term care, Medicaid may pay for nursing home residence, while the hospice benefit still pays for hospice care. Medicaid rules are set in large part by each state. Income and resource rules apply, and the details vary. This guide does not state those state details. Your state Medicaid office is the source for them.

The third path is long-term care insurance. Some policies pay benefits that can help with nursing home costs. Each policy is different. The benefit amount, waiting period, and covered settings are in the policy itself. Call the insurer, state that hospice care is involved, and ask what the policy pays for residence in a nursing home. Get the answer in writing.

The table below sums up the split between hospice care and room and board, and who usually pays for each part.

In short, the table shows the core rule of this guide: the hospice benefit pays for hospice care, and room and board needs its own payer.

For a wider view of all care costs together, see the main guide to paying for care. It helps you place nursing home residence, hospice, and home care on one page when you plan as a family.

• Cost part: Hospice care; What it covers: Hospice team visits, comfort care, hospice support; Who usually pays: Medicare hospice benefit, per its rules
• Cost part: Hospice prescriptions; What it covers: Outpatient drugs for pain and symptom control; Who usually pays: Patient may pay up to the small share in the rules
• Cost part: Respite stay; What it covers: Short inpatient rest stay for family caregivers; Who usually pays: Hospice benefit, with the patient share in the rules
• Cost part: Room and board; What it covers: Room, meals, and daily living in the nursing home; Who usually pays: Resident, family, Medicaid if qualified, or insurance
• Cost part: Extra facility items; What it covers: Services the facility lists as extras; Who usually pays: Ask in advance; often the resident or family

Questions to ask the hospice and the nursing home

Ask the hospice who pays for each part, in writing. Use the guide to questions to ask when choosing a hospice provider to shape your list. Good questions include which facility stays count as hospice stays, how respite works, and who you call on nights and weekends.

Ask the nursing home for its room and board rate sheet. Ask what the charge includes and what costs extra. Ask how the home bills when hospice is involved. Ask who sends the bill, how often, and when payment is due. Ask what happens if payment is late or funds run out.

Ask both sides about Medicaid. If the resident may qualify now or soon, ask who helps with the application. Nursing homes and hospice social workers often know the local process well. Start early. Applications take time, and residence charges keep running while papers move.

Ask about the move itself. If your loved one moves from home or a hospital into the nursing home, ask which day charges start. Ask what personal items can come. Ask how the hospice team and facility staff share updates with the family. A named contact person on each side helps a lot.

This is general information, not legal or financial advice for one family. Medicaid and insurance choices can affect a spouse and a family's future in large ways. A State Health Insurance Assistance Program counselor, legal aid office, or elder-law professional can review your case. That step is worth it before you sign long-term papers.

Diagram

Use the diagram when you meet the hospice and the nursing home. Point to each box as you ask about it. If a box has no clear answer, that is your next task. Do not let the room and board box stay vague. Vague here becomes a large bill later.

What to do next

Use this checklist in order. Check off each step as you finish it.

Hospice in a nursing home can be good, kind care. The hospice team brings comfort skills. The facility gives round-the-clock presence. Families often value that mix at a hard time. The money side just needs clear eyes from the start.

Name the two costs out loud at every meeting. Hospice care is one. Room and board is the other. Ask who pays each one, and get it in writing. With that habit, you protect your loved one, your family, and the funds that may be needed for a spouse or for care still to come.

• [ ] Ask the hospice to confirm hospice eligibility and what hospice care includes.
• [ ] Ask the nursing home for its room and board rate in writing.
• [ ] Ask what the room and board charge includes and what costs extra.
• [ ] Ask which stays count as hospice stays and which days are resident days.
• [ ] Ask how respite care works and who pays each part of a respite stay.
• [ ] Check private funds and estimate how long they may last at the stated rate.
• [ ] Ask the state Medicaid office or a counselor about long-term care Medicaid.
• [ ] If there is a long-term care policy, call the insurer and get its answer in writing.
• [ ] Ask who sends each bill, how often, and when payment is due.
• [ ] Keep hospice papers and facility bills in one folder, by date.
• [ ] Ask a SHIP counselor, legal aid, or an elder-law professional to review big choices.
• [ ] Set a family date to review costs and the care plan together.