Hospice and palliative care are not the same thing, and neither means giving up. A San Diego family's guide to what Medicare pays and how to start.
By Diane Whitfield, CSA · July 14, 2026
Families in San Diego often hear the two words used interchangeably by a discharge planner at Scripps Mercy or Sharp Memorial, and understandably assume they mean the same thing. They don't. Palliative care is specialized comfort care — pain control, symptom management, help with the emotional weight of a serious diagnosis — that can run alongside curative treatment at any stage of an illness. A 79-year-old in Poway getting chemotherapy can have a palliative care team managing nausea and fatigue at the same time.
Hospice is a specific Medicare benefit for someone whose physician certifies a life expectancy of six months or less if the illness runs its usual course, and who chooses comfort-focused care over treatment aimed at curing the underlying disease. The distinction matters because it determines who pays and what the team is allowed to do. It does not mean the family has given up, and it is not a one-way door — patients can revoke hospice and return to curative treatment, and a meaningful number improve enough to be discharged from hospice entirely.
Under Medicare Part A, the hospice benefit covers the interdisciplinary team — a physician, nurses, a social worker, a chaplain, home health aides, and trained volunteers — plus all medications related to the terminal diagnosis, durable medical equipment (hospital bed, oxygen, wheelchair), medical supplies, and short-term respite and inpatient care for symptom crises. For most San Diego families the out-of-pocket cost is effectively zero: no deductible, and at most a small copay per prescription. Medi-Cal covers hospice on very similar terms, and most private plans and the VA San Diego Healthcare System (La Jolla) do as well.
What hospice does not cover is room and board. This is the single most common and most painful misunderstanding we see. If a parent is living in an assisted living community or a board-and-care home in Chula Vista or Encinitas, hospice pays for the care team that comes to them — but the family still owes the facility's monthly rent. If the parent is at home, hospice provides visits, not around-the-clock caregivers. A typical hospice schedule is a nurse two or three times a week and an aide a few times a week for bathing. The hands-on hours in between still fall to family or to privately paid in-home care.
Roughly 90% of hospice care in San Diego is delivered wherever the person already lives — a house in Clairemont, an apartment in Oceanside, a six-bed RCFE in Serra Mesa, or a skilled nursing facility. Hospice agencies are licensed by the California Department of Public Health and Medicare-certified, and San Diego County has dozens of them, ranging from large nonprofits to small local providers. You have the legal right to choose your agency; you are not obligated to accept whichever one the hospital's discharge planner names first.
When symptoms cannot be controlled at home, the Medicare benefit also covers general inpatient care in a hospice facility or contracted hospital bed, and up to five consecutive days of respite care in a facility so an exhausted family caregiver can rest. A handful of freestanding hospice houses operate in the county. Ask any agency you interview directly: where do you provide inpatient care, and how fast can you get us there at 2 a.m.?
Any physician can make a hospice referral, but so can you. Families are allowed to call a hospice agency directly and request an evaluation; the agency will then coordinate certification with the treating doctor. There is no cost for that conversation. The most common regret we hear from San Diego families is not that they called hospice — it is that they waited. The national median length of stay on hospice is under three weeks, which means many families get only days of support from a benefit designed to give them months.
Good triggers to make the call: repeated hospitalizations or ER visits over a few months, significant unintended weight loss, a dementia diagnosis where your parent can no longer walk, speak in sentences, or eat without help, or a doctor who answers "would you be surprised if this person died within a year?" with "no." Two starting points that cost nothing: the San Diego County Aging & Independence Services line at 800-339-4661, and Medicare's Care Compare tool, which publishes quality and family-satisfaction scores for every certified hospice in the county. If the person is in a licensed RCFE, you can also check that facility's inspection and complaint history at ccld.dss.ca.gov before layering hospice on top of it.
A local senior advisor can help you sort which agencies serve your parent's ZIP code, which board-and-care homes in San Diego routinely accept hospice residents, and how to cover the room-and-board gap that Medicare leaves open.
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