Hospice in Assisted Living: A Tempe Guide

The doctor says it is time to talk about hospice. Your mother has been in an assisted living community in Tempe for two years. She knows the staff, she has a chair by the window, and the first question out of your mouth is the one nobody at the hospital seems to have anticipated: does this mean she has to move?

Often she can stay, but that depends on two separate things. Medicare will pay for hospice care wherever she lives. The community has to be willing and able to keep her. The first is settled by federal rules. The second is a conversation to have this week.

One thing to say before anything else: electing hospice is a decision for your mother and your family, on your own timeline. Nothing here is a recommendation that she elect it. Asking the questions below does not commit anyone to anything.

If you are still working out what hospice is and how it differs from palliative care, start with our guide on hospice versus palliative care. This article picks up from the point where hospice is on the table and your parent already lives somewhere.

Medicare will follow her to where she lives

Medicare is direct about this. You can usually get Medicare-approved hospice care in your home or other facility where you live, like an assisted living facility or a nursing home.

Hospice is not a place. It is a team and a benefit that comes to the person. For as long as the community can meet her needs, her apartment stays her apartment.

The part that surprises families: hospice does not pay the rent

Medicare's hospice benefit does not cover room and board. Its own page lists room and board among the things Medicare will not cover once the hospice benefit starts, and its costs section says you may have to pay for room and board if you live in a facility and choose to get hospice care. Separately, Medicare.gov states plainly that "Medicare doesn't pay for long-term care," which is what assisted living is.

So the assisted living bill does not stop. Whether it changes at all is up to the community, not Medicare. In our experience assisted living across the Phoenix metro runs roughly $5,000 to $10,000 a month depending on the community and the level of care, and that continues alongside hospice.

What hospice adds is clinical care on top, at no cost for covered services from a Medicare-approved provider. Families sometimes hear "hospice is covered" and assume the whole arrangement becomes free. Two separate bills, one of which Medicare pays and one of which you keep paying.

One exception is worth knowing. If the hospice team determines she needs short-term inpatient or respite care that they arrange, Medicare will cover that stay. You may pay 5 percent of the Medicare-approved amount for inpatient respite care, and that copayment cannot exceed the inpatient deductible amount.

What electing hospice actually changes

To be eligible, she needs Part A and must meet all of these: her hospice doctor and her regular doctor, if she has one, certify that she is terminally ill with a life expectancy of 6 months or less; she accepts comfort care instead of care intended to cure her illness; and she signs a statement choosing hospice instead of other Medicare-covered treatments for her terminal illness and related conditions. That Hospice Election Statement must be completed before any hospice services begin.

Once the benefit starts, Medicare will not cover:

• Treatment intended to cure the terminal illness or related conditions.
• Prescription drugs meant to cure the illness, as opposed to drugs for symptom control or pain relief.
• Care from any hospice provider the hospice medical team did not set up. She can still see her own doctor or nurse practitioner if she has chosen that person as the attending medical professional helping supervise her hospice care.
• Room and board.
• Care as a hospital outpatient or inpatient, or ambulance transportation, unless the hospice team arranged it or it is unrelated to her terminal illness and related conditions.

That last one has a carve-out families should not miss. If something happens that is unrelated to her terminal illness, Original Medicare coverage applies in the usual way. Where families get caught is with symptoms that are clearly part of the terminal illness, such as uncontrolled pain or a breathing crisis, handled outside the hospice team. Medicare's guidance is to contact the hospice team before getting those services, or you might have to pay the entire cost.

There is also a written protection worth using. You can ask the hospice provider for a list of items, services and drugs they have determined are unrelated to the terminal illness, with the reasons why. They must give it to you within three to five days of your request, and you can ask for it as an addendum to the Election Statement. In a situation this confusing, having that in writing is worth the phone call.

It is not a one-way door

Two things are worth knowing.

First, hospice is not a six-month countdown that ends automatically. The benefit runs as two 90-day periods followed by an unlimited number of 60-day periods. After six months, care continues as long as the hospice medical director or hospice doctor recertifies that she is still terminally ill, following a face-to-face meeting with the hospice doctor or hospice nurse practitioner.

Second, she can stop. Medicare says you always have the right to stop hospice care at any time, and if health improves or the illness goes into remission, she or her doctor may decide hospice is no longer needed. Stopping requires signing a form with an end date. It can also go the other way: if her doctor determines her life expectancy is no longer 6 months or less, the hospice may discharge her until a doctor certifies again that she is terminally ill.

One safeguard from Medicare's own guidance: nobody on the hospice team should ask her to sign forms about stopping hospice care at the time she starts it. If that happens, it is worth questioning.

She also has the right to change hospice providers once during each benefit period, which matters if the first one is not a good fit.

As for cost, she pays nothing for hospice care from a Medicare-approved provider, up to $5 per prescription for outpatient drugs for pain and symptom management, and the respite coinsurance described above. Original Medicare still pays for covered care for health problems unrelated to the terminal illness, with the usual deductibles and coinsurance.

The questions to ask the community, not the hospice

These answers come from the assisted living community rather than from Medicare.

1. Can she stay here through the end? Arizona licenses assisted living to provide supervisory, personal, or directed care services, and not every community is set up for the higher levels. Ask plainly, now, what would cause them to say she has to move.

2. Do you work with the hospice we are choosing? Choice of hospice is supposed to be the family's. Ask whether the community has preferred relationships and whether they will work with yours.

3. Will the monthly rate change? Some communities reduce the level-of-care charge when hospice takes over part of the care. Others change nothing. Ask directly, and get the answer in writing, before hospice starts.

4. What happens overnight? Routine hospice visits do not put a caregiver in the room around the clock. Ask what the community's staff will and will not do at three in the morning, and whether private-duty caregivers are permitted in the apartment if the family wants to add coverage.

5. Who calls whom? Ask the community to call hospice first for symptoms related to her terminal illness, so the hospice team can direct care. Staff should still call 911 in an emergency. This is the conversation that heads off the most common billing surprises.

If she cannot stay

Sometimes the honest answer is that the current community is not equipped for what is coming. That is not a failure, and it is better to know early than during a crisis.

The options then are usually a community or care home licensed for a higher level of care, including the small licensed care homes common in the Valley, or an inpatient hospice facility if she meets certain conditions. Hospice itself can also continue at a different address, so changing where she lives does not mean starting the benefit over.

Moving someone at this stage is hard. It is worth asking the question early enough that a move, if it happens, can be planned rather than forced.

How we help

Integrity Senior Placement helps Tempe families through this, and the service is free to families. If the community cannot keep your mother through the end of her life, we can help you look at assisted living communities and care homes that are set up for it, and we can help you ask the questions above before you are in a hurry. Our hospice care support page covers how hospice works alongside a senior living community.

If you have just been told it is time for hospice and do not know what it means for where your parent lives, talk with a placement advisor. We work with families throughout Tempe and the East Valley.

Sources

• Medicare.gov: Hospice care
• Medicare.gov: Long-term care
• Arizona Department of Health Services: Assisted Living Facilities Provider Type Definitions

This article is for general information and is not medical, legal, or financial advice. If you are facing a medical emergency, call 911. Medicare rules and costs depend on individual circumstances and change over time, so confirm current details with Medicare or your parent's plan, and discuss your parent's situation with their physician and hospice team. Cost ranges reflect what Integrity Senior Placement sees in the Phoenix and East Valley market and are not a quote.

Published October 19, 2026.