Hospice at home in west county: choosing a hospice, the VA, and who pays for the extra hours

Type in home care with hospice St. Louis County into a search bar and you get two separate things wearing one phrase: the hospice benefit, which Medicare or the VA pays for, and the extra hours in the house, which somebody else does. This page is the local map for both: how to choose a hospice, what the VA offers a veteran, which agency on aging covers your address, and who pays for what.

How do we choose a hospice in St. Louis County?

Medicare's booklet gives three routes: talk to your doctor, visit Medicare.gov/care-compare to find Medicare-approved hospice providers in your area and compare them based on the quality of care they provide, and call your state hospice organization through 1-800-MEDICARE. The comparison tool itself is at Medicare.gov/care-compare; type a west county ZIP and choose hospice. The booklet adds that Medicare only covers your hospice care if the provider is Medicare approved, and that if you are in a Medicare Advantage plan the plan must help you locate one.

Missouri's health department describes hospice as a special way of caring for people who are terminally ill, and for their families, provided by a public agency or private company approved by Medicare, and lists the services a plan can include. This site does not rank or recommend hospices, and it will not say one is better than another. Ask each one the same questions: how often the aide comes in a routine week, how the on-call line works at night, whether they have volunteers who sit, how they handle respite and continuous care, and how soon they can start. The answers, side by side, will tell you more than any list.

Does the VA cover hospice at home for a veteran?

Yes, for Veterans enrolled in VA care who meet the clinical need for it. The VA describes hospice as comfort care provided to Veterans and their families if the Veteran has a terminal condition, with less than 6 months to live, and is no longer seeking treatment other than palliative care, says it can be provided at home, and states that there are no copays for hospice care whether the VA provides it or an organization under VA contract does. The VA St. Louis Health Care System lists facilities at 1 Jefferson Barracks Drive and 915 North Grand Boulevard. Start with his primary care team or the social work office there.

Two other VA doors matter for the extra hours. The VA's own Homemaker and Home Health Aide program sends a trained person, supervised by a registered nurse, to help with personal care and daily activities so a Veteran can remain at home; ask the VA care team whether it fits alongside hospice. And a wartime Veteran on a VA pension may qualify for Aid and Attendance, a monthly amount added to the pension for those who need help with daily activities such as bathing, feeding and dressing. For the period from December 1, 2025 to November 30, 2026, the VA's net worth limit for pension eligibility is $163,699, and the maximum annual pension rate for a Veteran with no dependents is $29,093 with Aid and Attendance. The medical part of the application is VA Form 21-2680. That money is the family's to spend on hired hours. The VA Caregiver Support Line is 1-855-260-3274, Monday through Friday.

Which agency on aging covers your address?

Missouri has 10 Area Agencies on Aging covering every county, reachable through the Senior Resource Line at 1-800-235-5503 by ZIP code. For Ballwin, Chesterfield, Eureka, Glencoe, Grover, Pacific and Valley Park, that is Aging Ahead, which has served St. Louis, St. Charles, Franklin and Jefferson counties since 1973 with meals, senior centers, caregiving services and community options consulting. Inside the city limits it is the St. Louis Area Agency on Aging, at (314) 612-5918. Neither is a hospice and neither sits nights; both know what caregiver help exists in the county this month, which is more than any website does. United Way's 211 line in greater St. Louis answers around the clock.

Who pays for the extra hours hospice does not staff?

Lay it out in a column, because the confusion here costs families weeks.

• The hospice itself. Medicare Part A pays it: you pay nothing for hospice care from a Medicare-approved hospice provider, a copayment of up to $5 per outpatient prescription for pain and symptom management, and up to 5% for inpatient respite. The benefit runs two 90-day benefit periods followed by an unlimited number of 60-day benefit periods as long as the hospice doctor recertifies.
• Room, board, and a person in the house. Not the hospice benefit. Medicare does not cover room and board where she lives, and its home health page says it does not pay for 24-hour-a-day care at your home. Medicare's long-term care page states it flatly: Medicare does not pay for long-term care.
• MO HealthNet. Missouri Medicaid is different from Medicare, and the state says it can help with benefits not normally covered through Medicare, like personal care services, for those who qualify. Ask the hospice social worker whether she does.
• Long-term care insurance. Medicare's page notes you may be eligible for long-term care through Medicaid, or you can choose to buy private long-term care insurance. If a policy exists, find it tonight and read what it says about in-home personal care.
• The VA, as above, for a Veteran.
• Private pay. Missouri's third category of home care: private duty or private pay, funded privately or by insurance, no physician order, no state license for that type of company. This is the overnight chair, the extra bath, the meals. It sits beside hospice and never replaces it.

How the extra hours fit next to hospice

Tell the hospice. The booklet says the hospice must give or arrange all care you get for your terminal illness, so a hired caregiver is presence and personal care, briefed by the nurse, never a second medical opinion. Ask the nurse to meet the caregiver on the first day. Put the on-call number by the chair. The task-by-task split is in between the visits, and the night plan is in sleeping in shifts.