Hospice care in Philadelphia is a Medicare benefit that travels to the patient - here is what it covers, what it never pays for, and where families get blindsided.
By Philly Senior Advisor Care Team — Hospital & Veteran Transitions Team · August 1, 2026
The sentence lands the same way in almost every family meeting: someone on the care team says they are recommending hospice, and the room hears it as an announcement that treatment has failed. Families who start searching for hospice care in Philadelphia after that conversation almost always look for a building first - a place to move a parent into. That instinct is the first thing worth correcting, because in Pennsylvania hospice is a service that travels to the patient, not an address you relocate to. It is delivered in a rowhouse in Fishtown, an apartment near Rittenhouse Square, a personal care home in Roxborough, an assisted living residence in Media, or a skilled nursing facility in Abington. The hospice team comes to wherever the person already lives. Only a small share of hospice patients ever spend a night in a dedicated inpatient hospice unit, and when they do it is usually to get a symptom crisis under control rather than to move permanently. Understanding that hospice is a benefit rather than a place changes nearly every practical question that follows - starting with who keeps paying the rent.
The second thing families conflate is palliative care and hospice. Palliative care is symptom and comfort management that can run alongside aggressive treatment at any stage of a serious illness, and it is billed like any other specialty service. Hospice is a specific Medicare Part A benefit that requires a prognosis of six months or less if the illness follows its expected course, certified by two physicians - typically the attending physician and the hospice medical director. Electing hospice means signing an election statement that waives Medicare payment for curative treatment of that terminal condition, though care for unrelated conditions stays covered as usual. A patient at Penn, Jefferson, Temple, or Einstein can be receiving palliative consults for months before anyone raises hospice, and treating the two words as synonyms is how families end up either declining help they could have used earlier or agreeing to something they did not intend.
Once the election is signed, the hospice agency becomes responsible for an interdisciplinary team rather than a single visiting nurse. In practice that means a case-managing registered nurse who visits on a set schedule and is reachable around the clock, a hospice aide for bathing and personal care, a medical social worker, a chaplain if the family wants one, trained volunteers, and bereavement support for the family for roughly thirteen months after the death. The benefit also covers medications related to the terminal diagnosis, durable medical equipment such as a hospital bed, oxygen concentrator, wheelchair, or bedside commode, and routine medical supplies - all delivered to the home rather than picked up. For a family managing a parent in a three-story Germantown twin with a bathroom on the second floor, the equipment piece alone often resolves a problem they had been quietly failing at for months. There is no copay for hospice services, and at most a small copay for outpatient drugs and inpatient respite under the standard Medicare rules.
What the benefit does not send is a caregiver. This is the single most consequential misunderstanding we correct, and it is worth being blunt about it. Hospice aide time is measured in visits and hours per week, not in continuous days of coverage, and the nurse visits are scheduled rather than resident. If your mother needs someone in the house overnight, hospice does not supply that person. Families across Greater Philadelphia fill that gap with private-duty in-home care at roughly $28 to $36 an hour, with unpaid family shifts, or by moving the person into a licensed setting. Ask any prospective hospice agency for expected aide hours per week in writing before you sign, because assuming hospice equals round-the-clock help is how an already exhausted adult child in Bensalem or Upper Darby ends up in crisis three weeks later.
The Medicare hospice benefit has four distinct levels of care, and the money works differently at each one, which is why the same family can be told two contradictory-sounding things a month apart. Routine home care is the default and covers the overwhelming majority of hospice days: the team visits wherever the patient lives. Continuous home care is a short-term crisis level, mostly skilled nursing hours delivered in the home to manage acute symptoms and keep someone out of the hospital. General inpatient care moves the patient temporarily to a hospital, a contracted inpatient hospice unit, or a contracted skilled nursing facility when pain, agitation, or breathing symptoms cannot be controlled where they are. Inpatient respite care is a short stay - up to five consecutive days at a time - in a contracted facility, arranged specifically to give the family caregiver a break rather than because the patient's condition changed. Not every agency serving the Philadelphia region has equal capacity at all four levels, and that is a fair thing to ask about directly.
Here is where the money turns. During general inpatient care and inpatient respite, the hospice is paid a rate that carries the cost of that facility stay. During routine home care, which is where nearly everyone spends nearly all of their hospice days, Medicare pays for the hospice team and nothing whatsoever toward housing. If your father lives in his own home, that distinction is invisible. If he lives in a personal care home or an assisted living residence with a monthly fee, it is the entire financial picture - and it catches families off guard at exactly the moment they have the least bandwidth to solve it.
Pennsylvania splits senior-care oversight between two agencies, and hospice sits on top of that structure rather than replacing it. Personal Care Homes (55 Pa. Code Chapter 2600) and Assisted Living Residences (55 Pa. Code Chapter 2800, created by Act 56 of 2007) are licensed by the Pennsylvania Department of Human Services. Nursing homes are licensed separately by the Pennsylvania Department of Health under 28 Pa. Code Chapter 211, with federal CMS certification layered on. Bringing hospice into any of them requires an agreement between the hospice agency and the residence, and it does not change what the residence is licensed to do. A personal care home must still be able to meet the resident's needs within the terms of its own license - a resident whose care needs escalate past that ceiling may need a supplemental service plan or, in some cases, may not be able to stay. Raise this before a decline happens, not after, and get the home's position in writing.
Meanwhile the monthly fee keeps arriving. Assisted living across Greater Philadelphia runs roughly $4,800 to $6,900 a month, dementia-focused settings run roughly $6,200 to $8,600, and skilled nursing runs roughly $11,000 to $14,000, with Main Line addresses like Bryn Mawr, Wayne, and Villanova and much of Chester County at the top of those ranges. Community HealthChoices, Pennsylvania's mandatory managed-care Medicaid program for long-term services and supports, may cover the personal-care services piece in a licensed residence but never covers room and board. If the resident is Medicaid-eligible in a nursing facility, the room-and-board portion is generally handled through a hospice room-and-board arrangement rather than disappearing - but confirm the specifics in writing with both the CHC managed care organization and the facility business office before electing, because the mechanics vary. And if your parent is enrolled in a LIFE program - Pennsylvania's brand of the National PACE model, entirely separate from the state's PACE and PACENET prescription subsidy - electing the Medicare hospice benefit requires its own coordination conversation with the LIFE center first.
For veterans enrolled in VA health care, hospice and palliative care are part of the Standard Medical Benefits Package, and the VA route carries one significant advantage over the Medicare benefit: the VA does not require a veteran to give up disease-directed treatment in order to receive hospice. That concurrent-care approach removes the hardest tradeoff in the whole decision - the moment a family feels they are choosing between comfort and continuing to fight. The Corporal Michael J. Crescenz VA Medical Center in University City coordinates palliative and hospice services for veterans across the Philadelphia region, and the VA can also authorize care through a community hospice agency closer to home when travel into the city is impractical for a family in Doylestown, West Chester, or Lansdale. Start that conversation with the VA social worker or palliative care team rather than waiting for a discharge planner to raise it, and keep the VA Caregiver Support Line, 1-855-260-3274, somewhere you can find it at 11 p.m.
VA Aid and Attendance is a separate matter and worth keeping separate in your head. It is a pension benefit paid to an eligible wartime veteran or surviving spouse, and it does not go away when hospice begins - which makes it one of the few resources that can actually be pointed at the room-and-board gap in a personal care home or assisted living residence while Medicare or the VA covers the clinical care. County veterans service officers across Philadelphia, Montgomery, Bucks, Delaware, and Chester counties file these claims at no charge, as does the Pennsylvania Department of Military and Veterans Affairs, which also operates the Southeastern Veterans' Center in Spring City. If a placement agency offers to handle an Aid and Attendance claim for a fee, that is your signal to go to the county office instead.
Hospice agencies are licensed by the Pennsylvania Department of Health and, when Medicare-certified, are surveyed against federal requirements as well - so there is a public record to read before you choose. Medicare's Care Compare tool publishes hospice-level quality measures and results from the standardized survey of bereaved family caregivers, which is the closest thing available to asking previous families how it actually went. Use the Department of Health's facility search to confirm current licensure. Then ask the questions the brochures do not answer: who physically comes out at 2 a.m. on a Sunday and how quickly, how many aide hours per week you should expect in writing, whether the agency has a contracted inpatient unit and where it is, how often they actually deliver continuous home care, and whether they routinely serve your specific township in Bucks or Chester County rather than only the parts of it closest to the city. Vagueness on the after-hours question is the most reliable warning sign.
Two rights are worth knowing before you sign anything. A patient can revoke the hospice election at any time and return to standard Medicare coverage, and a patient can change hospice agencies once per benefit period - neither decision is permanent, and no agency should imply otherwise. If the person lives in a licensed personal care home, assisted living residence, or nursing facility, the Pennsylvania State Long-Term Care Ombudsman Program, housed within the Department of Aging, is an independent advocate for concerns about the residence itself, distinct from any complaint about the hospice. For wraparound support, the Philadelphia Corporation for Aging serves the city, with Montgomery County Aging and Adult Services, the Bucks County Area Agency on Aging, Delaware County's COSA, and Chester County Department of Aging Services covering the collar counties. And for the caregiver's own logistics, SEPTA's Shared-Ride program for Pennsylvanians 65 and older is an underused way to keep a spouse's own medical appointments from collapsing under everything else.
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