The financial aspect of hospice care is a significant concern for many families, especially when a loved one is receiving care outside of their own home. Hospice care is a comprehensive program focused on comfort and quality of life for individuals with a terminal illness. This care includes clinical services, medications, equipment, and emotional support, which are typically covered by insurance. However, when care occurs in a facility, the family is responsible for a separate expense known as room and board. This expense covers the patient’s daily living costs and is a primary financial burden for many families.
The Critical Difference Between Hospice Care and Room and Board
The distinction between the clinical hospice benefit and room and board (R&B) is a matter of federal regulation. The Medicare Hospice Benefit, which sets the standard for most insurance plans, covers all services related to the terminal illness, such as nursing care, medications, and medical equipment. This benefit is generally covered at 100% for eligible patients.
The benefit generally does not cover R&B costs for individuals receiving routine home care (RHC) while residing in a facility like a nursing home or residential hospice unit. R&B is considered a non-medical, custodial expense that covers daily necessities like meals, housekeeping, utilities, and facility maintenance. Since RHC is the most common level of hospice care, the R&B fee becomes the primary out-of-pocket cost for families using a residential setting.
There are specific circumstances where room and board is included in the covered hospice benefit. The facility costs are covered if the patient requires General Inpatient Care (GIP) for short-term symptom crisis management or Continuous Home Care (CHC) for intensive, round-the-clock care.
Medicare also covers up to five consecutive days of Inpatient Respite Care (IRC). IRC is short-term care provided in a facility to give the primary caregiver a rest period, and this coverage includes the room and board charge.
Standard Costs and Factors Influencing Room and Board Rates
The daily cost for room and board is the direct expense families must cover when the patient is not receiving a covered level of inpatient care. These rates vary significantly, typically ranging from $250 to $700 per day for an out-of-pocket residential fee. This means a family could face a monthly expense between $7,500 and $21,000, depending on the care setting.
The location of the facility is a major factor influencing this rate. Facilities in high-cost-of-living urban areas often charge a higher rate than those in rural settings. The type of facility providing the care is another variable. A dedicated hospice residential facility, which offers a home-like environment with 24-hour non-medical support, may have a different rate structure than a bed contracted within a Skilled Nursing Facility (SNF).
The level of amenities and services offered also impacts the daily room and board charge. Facilities with private rooms, specialized dining options, and a higher staff-to-patient ratio generally have higher fees. For instance, some specialized hospice facility care can average $500 to $1,000 per day. This reflects the higher overhead and comprehensive support structure of the residential setting.
Coverage Options and Financial Assistance Programs
Despite the high out-of-pocket costs for room and board, several programs exist to help mitigate the financial burden. While Medicare does not cover R&B for routine care, private insurance plans may occasionally offer a limited benefit for residential hospice costs, though they often mirror Medicare’s exclusion. If the patient is dually eligible for both Medicare and Medicaid, the latter becomes a crucial resource.
Medicaid, a state and federally funded program for low-income individuals, is the primary public funding source for R&B in a nursing home setting. If a Medicaid-eligible patient is receiving hospice care in a nursing facility, Medicaid will pay the hospice provider a per diem rate for the room and board. This benefit is often calculated at a rate equal to 95% of the state’s established skilled nursing facility rate.
Veterans may have additional options, as the Department of Veterans Affairs (VA) covers the full cost of clinical hospice care for enrolled veterans. However, the VA generally does not cover R&B in community facilities, similar to Medicare, unless the patient is admitted to a VA-owned or contracted inpatient facility. For those with insufficient coverage or limited resources, non-profit hospice organizations frequently offer charitable care programs, sliding-scale fees, or access to patient care funds. This ensures no one is denied necessary care based on the inability to pay.