When hospice begins
Whether she can stay turns on one piece of paper
A California care home cannot accept or keep a terminally ill resident receiving hospice care unless it holds a facility hospice care waiver. Not every home has one. And every waiver carries a limit the home chose for itself, which is why a home with an empty room can still tell you it has no space.
What the waiver is
Under 22 CCR 87632, a home that wants to accept or retain terminally ill residents and let them receive care from a hospice agency has to obtain a facility hospice care waiver from the Department of Social Services. To get one it has to apply in writing and, among other things, state the maximum number of terminally ill residents it wants at any one time, confirm it has read the hospice regulations and will comply with them, commit to following the parts of each hospice care plan that are its responsibility, and confirm it will enter an agreement with the hospice agency covering the care plan.
The Department will refuse a waiver if the home is not in substantial compliance with the Residential Care Facilities for the Elderly Act and the Title 22 rules, and will not approve one unless the home shows it can meet the care and supervision needs of terminally ill residents and says it is willing to provide additional care staff if a hospice care plan requires it.
Once an acceptable request is in, the Department has 30 days to say it has been approved, denied, or is deficient. A deficient request buys more time, not an approval.
The practical consequence: if a home offers to apply for a waiver for your parent, that is a month at the very best, and only if nothing is missing. Look at homes that already hold one at the same time.
The thing nobody mentions
The hospice limit is a number the home picked itself
When a home applies for the waiver, the regulation requires it to specify the maximum number of terminally ill residents it wants to have at any one time. The home chooses that figure. There is no number in the regulation, no ratio, no formula.
Which means a home can hold a perfectly valid hospice waiver, show you a lovely empty room, and still not be able to take your mother — because its own hospice places are full. Families hear “we don't have space” and assume beds. Ask the other question:
“What is the maximum number of hospice residents on your waiver, and how many of those places are taken today?”
What a waiver unlocks
A waiver can change a no into a yes
This is the least-known rule in the area, and for some families it is the whole answer.
Without a waiver
A home faced with a resident who has a restricted condition under 22 CCR 87612, or a prohibited one under 87615, has to apply to the Department for a written exception — documenting the condition, its plan for meeting the resident's needs, and its plan for minimising the impact on other residents.
With one
Under 22 CCR 87616(c) a home that has satisfied the hospice waiver requirements does not have to submit that exception request at all — provided the resident has been diagnosed as terminally ill, is receiving hospice services under a hospice care plan, and the treatment of the restricted or prohibited condition is specifically addressed in the hospice care plan.
All four of those have to be true, and the last one is the one that gets missed — if the hospice plan is silent about the condition, the exemption does not reach it. But it means a flat “we cannot take her, she has a feeding tube” may simply be wrong for a home that holds a waiver and a hospice plan that covers it. It is worth asking the question in those words.
If a home wants her moved
Five parties, one of them you
A home may not simply decide a hospice resident has to go to hospital or a nursing home. Under 22 CCR 87224(i), an urgent relocation of a terminally ill resident receiving hospice services to a licensed health facility requires that the resident's condition has changed and that a joint determination has been made by:
- the Department of Social Services,
- the resident, or their health care surrogate decision maker,
- the resident's hospice agency,
- a physician, and
- the licensee — the home itself.
— that continued retention in the facility poses a health and safety risk to her or to another resident. The home is one voice of five, and your family, or whoever holds her health care decisions, is another. The home must also follow the regulation's procedure for reducing transfer trauma.
This sits alongside the ordinary eviction rules rather than replacing them. If what you have been handed is a notice rather than a transfer, read what a 30-day notice has to contain.
Ask these five
On the phone, in this order
We do not know from the state's published register which Anaheim homes hold hospice waivers — it is not a field in it. So this is how you find out, and it takes one call.
“Do you hold a facility hospice care waiver from Community Care Licensing?”
This is the whole question. Without one, a home cannot lawfully accept or retain a terminally ill resident receiving hospice care. Ask to see it.
“What is the maximum number of hospice residents on your waiver, and how many of those places are taken right now?”
The home picked that number itself when it applied. It can hold a waiver, have an empty room, and still have no room on hospice. Almost nobody asks this and it is the question that saves a wasted week.
“Does your waiver cover my mother's specific condition, and is it addressed in the hospice care plan?”
A waiver plus a hospice plan that specifically addresses the condition is what lets a home retain somebody it otherwise could not. If the plan is silent on the condition, the exemption does not reach it.
“Which hospice agency do you have an agreement with, and can we keep ours?”
The home must have an agreement with the hospice agency about the care plan. If your parent is already with a hospice they trust, establish early whether that agency can work in that building.
“Will you add care staff if the hospice care plan calls for it?”
A home cannot get a waiver at all without stating it is willing to provide additional care staff where the hospice plan requires. Ask them to say it to you too.
Common questions
Hospice in a care home, answered
- Can my mother stay in her care home if she goes on hospice?
- Only if that specific home holds a facility hospice care waiver from the California Department of Social Services. Under 22 CCR 87632, a residential care facility for the elderly must obtain that waiver in order to accept or retain a terminally ill resident and let them receive care from a hospice agency. It is not automatic and not every home has one. Ask the home directly, and ask to see it.
- A care home has a hospice waiver but says it has no room — it has empty beds. Can that be right?
- Yes, and this is the part families are not told. When a home applies for the waiver it has to specify the maximum number of terminally ill residents it wants to have at any one time. That number is the home's own choice, not a figure set by the regulation. So a home can hold a valid waiver, have a vacant room, and still be at its hospice limit. Ask what the number is and how many of those places are currently filled.
- How long does it take a care home to get a hospice waiver?
- Too long to wait for. The Department has 30 days from receipt of an acceptable request to say whether it is approved, denied or deficient — and if the request is deficient the clock effectively restarts while the home supplies more information. A waiver will also be denied outright if the home is not in substantial compliance with the Residential Care Facilities for the Elderly Act and the Title 22 requirements. If a home offers to apply for one for your parent, treat that as a month at best, and look at homes that already hold one in parallel.
- My mother has a condition a care home said it could not accept. Does hospice change that?
- It can, and this is the least known rule in the area. Regulation 22 CCR 87616(c) says a facility that has satisfied the hospice waiver requirements does not need to submit a written exception request for a resident with a restricted condition under 87612 or a prohibited condition under 87615 — provided that resident has been diagnosed as terminally ill, is receiving hospice services under a hospice care plan, and the treatment of that condition is specifically addressed in the hospice care plan. All of those have to be true. But it means a flat 'we cannot take her' may be wrong for a home that holds a waiver.
- Can a care home move a hospice resident out to a hospital or nursing home?
- Not on its own say-so. Under 22 CCR 87224(i), urgent relocation of a terminally ill resident receiving hospice services to a licensed health facility requires that the resident's condition has changed and that a joint determination has been made by the Department, the resident or their health care surrogate decision maker, the resident's hospice agency, a physician, and the licensee, that continued retention poses a health and safety risk. That is five parties, and one of them is your family. The home must also follow the procedure for reducing transfer trauma.
- What do we have to sign?
- Under the terms the Department attaches to every waiver, a written request has to be signed by the resident, or by their health care surrogate decision maker, allowing them to be accepted or kept in the facility while receiving hospice services. It is kept in the resident's record at the home. Separately, the home has to notify the Department in writing within five working days of hospice care starting, or within five working days of admitting someone already on hospice, giving the resident's name, the date of admission, and the hospice's name and address.
Read at source: 22 CCR 87632 (hospice care waiver, including the maximum-number requirement at (a)(1), the resident's signed request and the five-working-day notice at (d), and the 30-day determination at (e)); 87616(c) (no written exception required for a waiver-holding facility); 87612 and 87615 (restricted and prohibited health conditions); 87633 (hospice care for terminally ill residents); and 87224(i) (urgent relocation). General information for families, not legal or medical advice.
Last reviewed . Regulation citations are re-read at source whenever this page is revised.
Tell us she is on hospice and we will start with the waiver question
It is the first thing we ask a home, before room size, before price. If you are trying to keep her where she is, we will tell you whether the rules are on your side.
Tell us who you are looking after
Four short questions. Nothing you answer is shared with a facility until you say so.
Prefer to talk now? (714) 975-9652, open every day until 6pm.