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What's the Difference Between Hospice and Assisted Living?

hospice vs assisted living

Hospice Services and Assisted Living Communities: They’re Compatible

Hospice care and assisted living are not an either-or phenomenon. Hospice care is provided in the assisted-living facility (ALF) setting. Here are the facts:

  • Residents do not have to leave their ALF to receive hospice services
  • Hospice is an option that families and the ALF staff can make with a doctor’s referral
  • Hospice services include medical, emotional and psychosocial care focused on calidad de vida al final de la vida, and they are provided wherever the patient calls home
  • It’s time for hospice services within the AL when signs of decline are evident

What Are the Signs of Decline?

Experts agree that hospice is most beneficial when provided for at least three months. Factors that determine the need for hospice vary by individual. Physical symptoms may include any or all of the following:

  • Dolor crónico
  • Infecciones frecuentes
  • Repeat hospitalizations
  • Weight loss/swallowing difficulty
  • Inability to ambulate independently
  • Náuseas/vómitos
  • Insuficiencia respiratoria/dependencia a oxígeno
  • Progressive decline due to intolerance to, or despite use of, curative medical therapies 

Hospice Can Help Residents Stay in their Assisted Living Facility

Sometimes, it is only with hospice that a declining resident can remain in their ALF. State regulations vary, but symptoms such as stage-3 and stage-4 wounds, significant weight loss or becoming bedbound may require an assisted living resident to move to a skilled nursing facility or hospital. Often, that resident doesn't return to the community, which means they lose the familiarity of home, friends and routine at a critical time.

But a resident who qualifies for hospice, with all the hands-on care and documentation it provides, usually can remain in the facility—to the benefit of the resident, the family and the ALF community.

Hospice Manages a Terminal Illness Within the ALF

The focus of hospice is on the patient, not the disease. Clinical eligibility for hospice care depends upon a physician's documentation that an individual's life expectancy is six months or less if the illness runs its normal course. Hospice patients are evaluated routinely by a hospice physician to verify continued hospice eligibility. 

ALFs are homes-not hospitals. They typically have a minimum number of clinicians on staff, with aides providing most of the residents' care. It would be challenging for most ALFs to meet the complex daily demands of a terminally ill resident.

When a hospice-eligible ALF resident selects hospice care rather than curative care, an interdisciplinary team of hospice professionals steps in to work with the resident, family, ALF staff and the resident’s physician to develop an integrated plan for comfort care that meets the resident’s needs.

The team addresses medical, psychosocial, emotional and spiritual issues. They bring their end-of-life skills, compassion and knowledge to the bedside. They evaluate pain and symptoms during every visit.

At night, on weekends and holidays, experienced hospice staff are "on-call" to answer questions or make a "house call." When medically necessary, cuidado continuo—one of the Medicare hospice benefit’s four levels of care—places shifts of clinicians at the bedside for up to 24 hours a day until symptoms are under control, ensuring that an assisted living resident does not have to go to the hospital for a medical crisis.

Hospice provides and delivers home medical equipment related to the terminal illness to the ALF, easing the financial burden for a resident and their family. The hospice team gets to know the resident and family, encouraging them to talk about their wishes and fears. They offer quality of life to residents at the end of life in very personal ways: music therapy, pampering-even a visit from a Paw Pal® named Pancho and his owner.

Hospice Provides Support for Family—and Staff

For loved ones, friends and the ALF staff, bereavement issues can surface even before the resident's death and continue long after. Hospice experts provide counseling, memorial services, support groups and education to address grief, loss and other end-of-life issues to those who are grieving.

The ALF's hospice partner should also offer in-services to increase staff understanding of and familiarity with a variety of end-of-life care topics. As they work with the ALF staff, the hospice team should encourage open, ongoing discussions about end-of-life challenges, even providing continuing education (CE) credits toward staff education.

And because hospice is a Medicare benefit, it is free to Medicare/Medicaid beneficiaries (and covered by most private insurance). There are no out-of-pocket costs to the patient or family for team visits, home medical equipment, medications and supplies related to the terminal illness.

With hospice, patients are often able to age—and die—in place.

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The Four Levels of Hospice Care

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