Hospice in a Board and Care Home: How End-of-Life Care Works in a 6-Bed RCFE

When a parent’s illness reaches the point where comfort matters more than cure, many families hope for one thing: that Mom or Dad can spend their final months somewhere peaceful, with familiar caregivers, not in a hospital. For many San Diego families, hospice in a board and care home makes that possible. A small 6-bed home and a hospice team working together can provide close, gentle care through the end of life.

This guide explains how hospice in board and care works in California: what a hospice waiver is, who does what between the home’s caregivers and the hospice team, what Medicare covers and what it does not, how conditions that would normally require a nursing home are handled, what happens in an emergency, and what to ask before choosing a home. It is written for families in San Diego County but reflects California rules that apply statewide.

Can Someone Receive Hospice in a Board and Care Home?

Yes. In California, a resident can receive hospice in a board and care home if the home holds a hospice care waiver from the Department of Social Services and the resident is enrolled with a licensed, Medicare-certified hospice agency. The home’s caregivers provide daily care, and the hospice team adds nursing, aide visits, medications and emotional support.

Board and care homes are licensed as Residential Care Facilities for the Elderly (RCFEs), and the hospice rules are in Title 22, sections 87632 and 87633. Many board and care homes in San Diego hold hospice waivers, and some focus on end-of-life care. For a parent who already lives in a home, hospice often means they can stay in their own room instead of moving.

Hospice itself is a Medicare benefit for people with a terminal illness and a life expectancy of six months or less if the illness runs its normal course, as certified by a doctor. It focuses on comfort rather than curative treatment. Our page on hospice care in San Diego explains the benefit more broadly, and our guide to palliative care explains how comfort care can begin earlier.

What Is a Hospice Waiver and Why Does It Matter?

A hospice waiver is approval from California’s Department of Social Services that allows an RCFE to accept or keep residents who are receiving hospice care. Without one, a home generally cannot keep a terminally ill hospice resident. With one, the home must follow added rules for care plans, staff training, reporting and coordination with the hospice agency.

Under section 87632, a home requesting a waiver must:

• State the maximum number of hospice residents it will care for at one time
• Agree to comply with the hospice regulations and follow each resident’s hospice care plan
• Enter into an agreement with the hospice agency about the resident’s care
• Show it can meet the needs of terminally ill residents and add staff if a care plan requires it
• Notify the Department in writing within five working days when hospice starts for a resident or a hospice resident is admitted

The Department can deny a waiver if the home is not in substantial compliance with licensing rules. This is one more reason to check a home’s inspection history, which our guide to RCFE inspection reports in California explains.

Who Provides Care: the Home or the Hospice Team?

Both. The board and care home’s caregivers provide around-the-clock daily care: bathing, toileting, repositioning, feeding help, medications and companionship. The hospice team visits on a schedule and as needed, providing nursing, symptom management, aides, a social worker, a chaplain and medical equipment. A written hospice care plan spells out each party’s role.

Under section 87633, the hospice care plan must include:

• Contact information for the hospice agency and the physician, including a 24-hour emergency number
• The hospice services provided in the home, with type and frequency
• The hospice’s primary contact and the home’s primary and alternate caregivers
• The home’s responsibilities, including medications, supplies, records and communication
• Any training the home’s staff need, and who will provide it

The hospice must provide resident-specific training to the home’s staff before care begins, and a licensed hospice professional must oversee controlled medications. Staff who are not licensed professionals cannot perform procedures that legally require one.

How Does Hospice in Board and Care Handle Serious Medical Conditions?

Hospice creates an important exception to California’s health condition rules. A board and care home with a hospice waiver can accept or keep a terminally ill resident with restricted or even prohibited conditions, such as a stage 3 pressure injury or feeding tube, if the resident is on hospice and the condition is addressed in the hospice care plan.

Normally, Title 22, section 87615 prohibits conditions such as stage 3 and 4 pressure injuries, gastrostomy tubes and total dependence on others in an RCFE. Under section 87633, those limits do not force a move for a hospice resident when the conditions are met, and no separate exception request is needed. Our guide to restricted health conditions in California RCFEs covers those rules in full.

Bedridden hospice residents may also stay if the home meets the rules for care of bedridden residents (section 87606). Ask any home whether it is approved for bedridden or non-ambulatory residents, since that affects whether your parent can remain as they decline.

What Does Medicare Pay For, and What Does the Family Pay?

Medicare’s hospice benefit covers the hospice team’s services, medications for comfort and symptom control, and medical equipment and supplies related to the terminal illness, usually at little or no cost. It does not pay room and board. Families still pay the board and care home’s monthly rate, typically $5,500 to $9,500 in San Diego in 2026.

What Medicare hospice covers, according to Medicare:

• Nursing visits, hospice aide visits, social work and spiritual care
• Medical equipment such as hospital beds, wheelchairs and oxygen related to the terminal illness
• Medical supplies related to the terminal illness, such as wound care materials, when part of the care plan (ask the hospice whether incontinence supplies are included)
• Medications for pain and symptoms, with a small copay per prescription of up to $5
• Short-term inpatient respite care to give caregivers a break, with a small coinsurance

What it does not cover: room and board in a home, assisted living or nursing home, and curative treatment for the terminal illness. Some board and care homes adjust the rate upward when a resident’s care needs rise near the end of life. Ask about this up front. Our guide to what’s included in a board and care monthly rate covers how rates change.

What Happens in an Emergency During Hospice?

For a hospice resident with a qualifying advance directive or POLST, California rules allow board and care staff to call the hospice agency instead of 911 for a life-threatening emergency related to the terminal illness. The hospice nurse then guides care. This helps avoid unwanted hospital trips in a person’s final days.

How to prepare:

• Complete a POLST with your parent’s doctor that reflects their wishes, and make sure the home has a copy.
• Post the hospice’s 24-hour number where every caregiver can see it.
• Agree on family calls: who gets called, in what order, and at what hours.
• Discuss what is not related to the terminal illness. A fall with a suspected fracture may still call for 911.

Our guide to medical emergencies in board and care homes covers 911, ER trips and family notification more broadly.

Why Do Families Choose a Board and Care Home for Hospice?

Families often choose a board and care home for hospice because it combines a home setting with round-the-clock caregivers. In a 6-bed home, staff can check on a dying resident often, families can visit freely and sit at the bedside, and the setting is quiet. It is often far less expensive than 24-hour home care.

Benefits families mention most:

• Constant presence. Caregivers are in the house day and night, not just during hospice visits.
• Familiarity. A parent who already lives in the home stays with caregivers they know.
• A home setting for family gatherings, music, prayers and quiet time.
• Relief for family caregivers who could not provide 24-hour care at home.
• Cost. Paying a board and care rate is usually far less than around-the-clock home care. See our comparison of elder care homes and 24-hour home care.

For example, a family in Vista whose father has advanced heart failure might move him from the hospital into a 6-bed home with a hospice waiver near their house. Hospice nurses visit several times a week, caregivers check on him through the night, and the family visits every evening without having to manage his care. Our page on board and care in Vista covers that area.

What About Roommates and Other Residents?

California rules protect both the hospice resident and housemates. If a hospice resident shares a room, the roommate must sign a statement acknowledging the hospice arrangement and agreeing to give hospice staff and family access. If the roommate withdraws that agreement, the home must make other arrangements that fully meet the hospice resident’s needs.

Practical points for families:

• Many families choose a private room for hospice so visits can happen at any hour.
• Ask whether the home has a private room available if your parent’s needs change.
• Small homes often handle end-of-life care with great sensitivity toward other residents, who may have lived alongside your parent for months.

After a death, the home and hospice follow specific steps, and families have questions about belongings, fees and timing. Our guide to what happens after a death in a board and care home covers that period.

What Should You Ask Before Choosing a Home for Hospice?

Ask whether the home has a current hospice waiver, how many hospice residents it cares for now, which hospice agencies it works with, whether it can care for bedridden residents, and how overnight staffing works. Also ask whether the rate changes near end of life. Clear answers to these questions show real hospice experience.

Questions to bring:

• Do you have a hospice waiver, and how many hospice residents can you care for at once?
• Can my parent choose any Medicare-certified hospice, or do you prefer certain agencies?
• Is your overnight caregiver awake? How often are hospice residents checked at night?
• Are you approved for bedridden or non-ambulatory residents?
• Will the monthly rate change as care needs increase?
• Can family stay overnight in the final days?

For dementia-specific end-of-life care, see our guide to dementia and hospice, and for an overview of small homes, our page on board and care homes in San Diego.

How Elder Answers Helps

Elder Answers helps San Diego families find board and care homes with hospice waivers and real end-of-life experience, often within days of a hospital discharge. Our advisors personally visit the homes we recommend and know which have openings, private rooms, awake overnight staff and strong relationships with local hospice agencies.

Our help is free for families because homes pay us after move-in, and that fee does not change your rate. We share your information only with homes you choose. When time is short, moves can often happen within a few days. We have helped local families for well over a decade. Contact Elder Answers to find a home for hospice care.

Frequently Asked Questions About Hospice in Board and Care Homes

Can a resident receive hospice in a board and care home in California?

Yes, if the home has a hospice care waiver from the Department of Social Services and the resident is enrolled with a licensed, Medicare-certified hospice. The home provides daily care and the hospice team adds nursing, aides, medications and support under a written hospice care plan.

Does Medicare pay for a board and care home during hospice?

No. Medicare’s hospice benefit pays for hospice services, comfort medications and related equipment and supplies, but not room and board. Families continue to pay the home’s monthly rate, typically $5,500 to $9,500 in San Diego in 2026.

What is a hospice waiver in a board and care home?

It is approval from the California Department of Social Services that lets an RCFE accept or keep residents receiving hospice. The home must follow added rules for care plans, staff training, reporting and coordination with the hospice agency (Title 22, sections 87632 and 87633).

Can my parent stay in their board and care home if they become bedridden?

Often yes, if the home has a hospice waiver and meets California’s requirements for caring for bedridden residents. Ask the home directly whether it is approved for bedridden or non-ambulatory residents.

Will the board and care home call 911 during hospice?

For a hospice resident with a qualifying advance directive or POLST, staff may call the hospice agency instead of 911 for emergencies related to the terminal illness. For unrelated emergencies, such as a fall with an injury, 911 may still be appropriate.

Can we choose our own hospice agency?

Generally your parent can choose a Medicare-certified hospice. Some homes work most often with particular agencies and know their nurses well. Ask the home which agencies it works with and whether it accepts others.

Does the board and care rate go up during hospice?

It can. Some homes raise the rate when care needs increase near the end of life, such as frequent repositioning or full feeding assistance. Ask how the home handles this before move-in or before hospice starts.

How quickly can a hospice patient move into a board and care home?

Often within a few days if a home with a hospice waiver has an opening. The home will need a physician’s report and the hospice agency’s information. A local placement advisor can quickly identify homes with current openings.