When a loved one is already living in a nursing home, and their health begins to decline, many families assume that hospice care requires a transfer or a move to a different facility. That assumption causes real delays, and in some cases, it keeps families from accessing comfort-focused care that their loved one genuinely needs.

The truth is straightforward: if your loved one is a resident of a nursing home in Georgia, hospice can come to them. They do not have to move. The hospice team comes to the nursing home, works alongside the facility’s staff, and provides a layer of specialized comfort-focused care that the nursing home is not designed to provide on its own.

This guide covers what that process looks like, how costs are divided, what families are entitled to know and decide, and what to watch for when navigating the relationship between a nursing home and a hospice team.

Hospice Is a Service, Not a Location

This point is worth repeating because it changes how families think about their options.

Under Medicare’s guidelines, a nursing home or assisted living facility is treated as the patient’s current residence. That means Routine Home Care, the most common level of hospice, can be delivered there just as it would be delivered in a private home. Your loved one stays in their room. Their nursing home care continues. The hospice team visits regularly and provides the additional clinical, emotional, and spiritual support that falls within the hospice benefit.

What the Hospice Team Adds That the Nursing Home Does Not Provide

Nursing homes provide skilled nursing care, assistance with daily activities, and around-the-clock supervision. What they are not specifically structured to provide is comfort-focused, palliative care for a patient with a terminal diagnosis, along with the comprehensive family support that goes with it.

When a hospice team comes into a nursing home setting, they bring an additional layer of care that includes:

• A registered nurse 
• A certified nursing assistant 
• A social worker 
• A chaplain  
• Medications, supplies, and medical equipment 
• Bereavement support 
• On-call nursing support 

The hospice team does not replace the nursing home’s staff. The two teams work in parallel, each fulfilling their own responsibilities, with the hospice provider coordinating closely to make sure nothing overlaps or falls through the gaps. You can read more about the full scope of these services on our Family and Caregiver Support and Physical Support and Management pages.

How Costs Are Divided in a Nursing Home Hospice Setting

This is one of the most confusing aspects of nursing home hospice care, and families deserve a clear explanation.

Medicare covers the hospice services. Under Medicare Part A, the hospice benefit pays for hospice-specific care, medications related to the terminal diagnosis, and durable medical equipment.

Medicare does not cover room and board at the nursing facility. The cost of the nursing home stay itself continues under whatever arrangement was already in place before hospice began.

If your loved one does not have Medicaid, room and board costs may be covered by long-term care insurance, veterans’ benefits, or private funds. A hospice social worker can help your family understand what resources may be available.

For a full overview of how the Medicare hospice benefit works and who pays for what in different care settings, visit our Who Pays for Hospice page.

What Good Care Coordination Looks Like Between Two Teams

When hospice care is delivered in a nursing home, you will have two teams involved in your loved one’s care. Understanding how they should work together helps families know what to expect and what to watch for.

The nursing home is responsible for providing the day-to-day residential care your loved one was receiving before hospice began. The hospice team is responsible for managing the symptoms and needs related to the terminal diagnosis and for supporting the family through the process.

In a well-coordinated arrangement, you should see:

• Clear communication between the hospice nurse and the nursing home’s charge nurse 
• Hospice-provided equipment and supplies are delivered directly to the nursing home room 
• Nursing home staff who are aware of the patient’s hospice status and who understand which concerns to escalate to the hospice on-call nurse
• Family members who feel informed by both teams

Levels of Hospice Care That Can Apply in a Nursing Home

The care your loved one receives is not fixed at one level. Depending on what is happening clinically, different levels of care may be initiated and then stepped back down. 

Read more: Levels of Care 

Here is a brief overview of what may apply in a nursing home setting.

• Routine Home Care is the standard level of care. The hospice team visits on a scheduled basis. This is what most nursing home hospice patients receive for the majority of their enrollment.
• Continuous Care may be initiated during a period of acute medical crisis, such as severe unmanageable pain, respiratory distress, or terminal restlessness. This level of care is short-term and designed to stabilize the patient.
• Respite Care allows the patient to be temporarily placed in a contracted inpatient or nursing facility setting for up to five consecutive days, primarily to give a family caregiver a break. 
• Inpatient Care may be necessary if a patient’s symptoms temporarily cannot be managed within the nursing home setting and require the resources of a contracted inpatient facility.
• Transitional Care is a benefit unique to our organization. When a patient is actively declining but does not yet meet the clinical criteria for Continuous Care under Medicare guidelines, Transitional Care provides additional supportive presence to ensure that neither the patient nor the family is left without support during that vulnerable period.

How to Start Hospice Care in a Georgia Nursing Home

Starting hospice care in a nursing home typically involves a few coordinated steps.

A physician must certify that the patient has a terminal illness with a prognosis of six months or less if the illness follows its expected course. The patient or their legal decision-maker must consent to enrolling in the hospice benefit.

Once enrollment is complete, the hospice team conducts an initial assessment, develops a care plan in coordination with the nursing home staff, and begins scheduled visits within a short period.

If you are not sure whether your loved one meets the eligibility criteria, our team can help you understand what the clinical picture looks like and whether a hospice evaluation makes sense. No obligation comes with that conversation. 

For a detailed look at eligibility and when hospice referrals are appropriate, read: Hospice Referral Guide for Fulton County Clinicians

We Serve Nursing Home Residents Across 18 Counties in Georgia

Our team provides hospice care to residents across the greater Atlanta area, including patients living in nursing homes, memory care communities, and assisted living facilities throughout our service region. We have built working relationships with facilities across the area and are experienced in navigating the coordination that comes with layered care.

If your loved one is in a Georgia nursing home and you want to understand what hospice care could look like for your family, we are here to answer every question without pressure or obligation.

Call us any time at (470) 395-6567 or visit our Contact page to speak with a member of our team. We are available 24 hours a day, 7 days a week.

To see if we serve the county where your loved one’s nursing home is located, visit our Service Area page.