You may be looking at a facility because the care at home no longer fits inside the hands and hours available. The hospice nurse may still come. The hospice plan may still continue. That does not mean the hospice benefit pays for the place where your parent will live.

Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.

Medicare draws a line between hospice services and ordinary room and board. Under routine hospice care, Medicare generally does not pay the charge for living in an assisted living facility, nursing facility or residential hospice setting. Short-term inpatient care and respite care arranged by the hospice follow different rules. Do not use those short stays as the price model for a longer move.

Before you agree to a room, ask for two descriptions in writing: what the hospice will provide and what the facility will provide. Then ask the facility to put every family-paid charge on one page.

Start with the charge for living there

Ask the admissions person, “If hospice were not involved, what would we pay for this room and the care included with it?” That answer is your starting figure. It may include the room, meals, housekeeping and a defined amount of personal help. It may not include all the hands-on work your parent needs.

Request the complete fee schedule and a sample resident agreement. Look for:

  • The base room charge
  • The difference between a private and shared room
  • Any entrance, assessment, community or move-in fee
  • Charges based on a care level or points system
  • Medication management charges
  • Charges for help with bathing, dressing, toileting, transfers or meals
  • Laundry, transportation, escort and supply charges
  • After-hours or extra-staff charges
  • Bed-hold charges if your parent leaves temporarily
  • The notice required before the rate can change
  • The notice and charges that apply when the room is given up

Missouri Department of Health and Senior Services distinguishes residential care, assisted living, intermediate care and skilled nursing facilities by the accommodation, personal care, supervision and nursing they provide. A familiar name on a building does not tell you which licensed level applies to the particular room. Ask for the facility’s exact Missouri license category and ask whether that category can continue to serve your parent if the amount of assistance changes.

Find what makes the price rise

A quoted room rate can remain the same while the care charge changes. Ask the facility to show you how it assigns a care level and who can change that level. Do not settle for “as needed.” Ask what event leads to a reassessment, who performs it, whether you receive the result in writing and when the new charge begins.

What it costs: The Missouri median for non-medical in-home care is $33 an hour, per the CareScout (Genworth) Cost of Care Survey 2025 state data tables, released March 2026. New Plan Care's standard rate is $34 an hour with a four-hour minimum, so a visit starts at $136 (newplancare.com/services).

Walk through one ordinary day without interpreting any symptom. Use observable tasks: getting out of bed, using the toilet, changing clothing, eating, moving between rooms and calling for help overnight. For each task, ask whether the base rate includes it, whether there is a limit on how often staff will help and whether two staff members change the charge.

Then ask about work the facility may not do at all. A lower rate does not help if the facility expects the family to cover a task or hire a separate caregiver. Write “included,” “extra charge,” “family” or “outside help” beside every task. Blank spaces are where the estimate can come apart.

Do not pay twice for the same promised item

The federal hospice rule requires coordination when hospice serves a resident of a nursing facility. The written arrangement must divide responsibilities between the hospice and the facility, and the hospice plan of care must identify which provider is responsible for each agreed function. The rule places hospice medical direction, hospice nursing, counseling and hospice-related drugs, supplies and equipment on the hospice side. It places ongoing room and board care on the facility side.

You will probably not receive the contract between the hospice and the facility, but you can ask both parties to explain the division that applies to your parent. Put the same questions to each one:

  • Which equipment will hospice furnish in this room?
  • Which supplies will hospice furnish because they are related to the hospice plan?
  • Which personal-care tasks belong to facility staff?
  • Who handles a hospice-related call after the hospice office closes?
  • Who tells the family when either side changes its part of the plan?
  • Could the facility bill separately for anything hospice says it will provide?

If the answers differ, ask the hospice case manager and the facility nurse or administrator to resolve the difference before admission. Ask for the final division in the hospice plan of care, the facility service plan or another document you can keep.

Ask which kind of stay is being offered

“Hospice bed” can describe several different arrangements. It may mean a room where a person lives while receiving routine hospice visits. It may mean a short respite stay arranged by hospice. It may mean short-term general inpatient hospice care. Those arrangements do not carry the same coverage or admission conditions.

Ask the hospice to name the level of hospice care in plain words. Ask who decides when that level begins and ends. Ask the facility whether the family charge changes when the hospice level changes. If the room is offered only while a particular level is authorized, ask what happens when that authorization ends: whether your parent can remain, what the new rate would be and how quickly another decision would be required.

Medicare says the hospice team must arrange covered inpatient or respite care. If someone tells you to choose a facility and sort out coverage afterward, call the hospice first. You need to know whether the stay is hospice-arranged short-term care or an ordinary residential placement the family must fund.

Check every possible payer without counting it twice

Ask the facility which payment sources it accepts for this particular room. Do not rely on the statement that a facility “takes Medicare,” “takes Medicaid” or “works with the VA.” Those phrases do not establish that your parent’s room and board will be paid.

If your parent is a veteran, ask a VA social worker about eligibility for long-term care services and whether an authorization is required before admission. VA explains that some long-term care services may be available depending on enrollment, need, eligibility and local availability, while room and board in some residential settings is not covered. A service-connected status, pension payment or VA health enrollment is not by itself a promise that this room will be paid for.

If Medicaid may be relevant, ask the facility whether it accepts Medicaid for the licensed level under consideration, whether a Medicaid bed is available and what the resident would still owe. Ask the hospice social worker where the application stands, but get coverage and payment answers from the responsible program and facility.

For long-term care insurance, send the insurer the facility’s license type and proposed service plan. Ask whether the setting qualifies, whether an elimination period applies, what records are required and whether payment goes to the facility or the policyholder. Do not subtract a possible benefit from the family budget until the insurer confirms it.

Compare a full billing period, not one attractive number

Place each facility’s written figures in the same order: room, care level, recurring extras, one-time charges and services the family must still arrange. Add the private-duty help that would remain necessary. Mark any charge that can change after reassessment.

Then ask for a sample invoice with names removed. A fee sheet tells you what may be charged. An invoice shows how charges are grouped and how often extras appear. If the agreement and the sample invoice use different terms, ask the facility to match them for you.

You do not need to decide from a tour or a bedside conversation. You can say, “I need the family-paid amount, the hospice-paid services and the possible add-ons separated before I sign.” That is a reasonable request.

Carry one clear question into the decision

The useful question is not simply, “Does this place accept hospice?” Ask, “What will we pay for the room and daily care while hospice supplies its separate benefit?”

Keep the admission agreement, fee schedule, hospice plan and facility service plan together. Write down the names of the people who explained each charge. If home is still holding tonight, this work can wait until morning. If a move is being discussed now, ask the hospice social worker to help arrange one conversation with the facility before anyone promises the room.

This guide is grounded in Medicare hospice coverage, the federal hospice conditions for care in nursing facilities, guidance from the National Institute on Aging, Veterans Affairs, Missouri Department of Health and Senior Services, and national caregiver organizations. The underlying authorities are collected on the Sources page. For West St. Louis County starting points, see Local Help for Hospice Families.