St. Louis Hospice: Medicare Pays the Nurse. It Won’t Pay for the Room.
Revised October 15, 2026
How do doctors know when it’s time for hospice?
Doctors look at the pattern, not one test: repeat hospital stays, weight loss, more of the day spent in a bed or chair, and more help needed with daily life. For Medicare to cover hospice, the hospice doctor and the regular doctor, if there is one, must certify a life expectancy of six months or less, and the patient must choose comfort care over treatment meant to cure.
Keep reading ↓You are allowed to say the word first. Most families sit in the vinyl chair beside a hospital bed, at Barnes-Jewish or Mercy South or Christian, coffee going cold in a paper cup, the monitor ticking, and wait for a doctor to bring up hospice. You don’t have to wait. “Is it time to talk about hospice?” commits nobody to anything. It gives the doctor permission to answer you honestly.
You probably asked because something already changed, and you saw it before anyone said it. The wedding ring that spins on a thinner finger. The collar that gapes. The chair by the window that has become the whole day. The third trip to the emergency room since spring. Hospice teams name those same signs: frequent hospitalizations, significant weight loss, a growing inability to manage daily activities, and most of the day spent in a bed or chair. Together, they are a reason to ask.
The rule itself is short. For Medicare to cover hospice, the hospice doctor and the regular doctor, if there is one, certify a terminal illness with a life expectancy of six months or less. The person accepts comfort care instead of care to cure, and signs a statement choosing hospice. It is an estimate, not a countdown; the National Institute on Aging says doctors have a hard time predicting how long an older, sick person will live.
Then the money question, the one people whisper while their mother sleeps three feet away. Under Medicare, you pay nothing for hospice care from a Medicare-approved provider, apart from a copayment of up to $5 per prescription for pain and symptom drugs and up to 5% of the approved amount for inpatient respite. The line worth sending to a brother or sister: Medicare does not cover room and board if hospice care happens at home or in a nursing home. The nurse is covered. The rent on the room is not. And nothing locks behind you: a person can stop hospice at any time and restart it later if still eligible.
Here is what the hardest weeks can look like in a St. Louis hospice house. At Mercy’s de Greeff Hospice House on Kennerly Road, volunteers give each patient a handmade blanket, the kind you can tuck around cold feet, and there are no visiting hour restrictions, so a son can come straight from a night shift. At BJC’s Evelyn’s House, 16 beds on the Barnes-Jewish West County campus in Creve Coeur, ice cream is always available to guests, for the father who has not wanted anything else in days. BJC says inpatient hospice care in its hospitals has doubled over the past five years, and it is building a 12-bed Evelyn’s House on the Washington University Medical Campus, the first dedicated hospice house in the City of St. Louis.
Three things you can do before dinner. Ask the doctor that question, word for word. Look up hospices by ZIP code on Care Compare at Medicare.gov, the official CMS site for hospice quality, where family caregiver survey results are posted. And if you need someone to help sort out care, call the St. Louis Area Agency on Aging at 314-612-5918 in the city, or Aging Ahead at 636-207-0847 in the county. Everything here is general information; your doctor and the hospice team decide the individual case.
How do doctors know when it’s time for hospice?
Rarely from one test. They read the same pattern you have been watching from the chair: the repeat hospital stays, the weight coming off, the longer hours in bed, the help needed now for things that used to be easy. When that pattern points one way, the hospice doctor and the regular doctor can certify a life expectancy of 6 months or less, and the choice of comfort care passes to the person.
That word certify matters. It is a clinical judgment made in writing, and it is framed around the illness running its usual course, not around a date on a calendar. After the first 6 months, hospice can continue as long as the hospice doctor recertifies, after a face-to-face visit, that the person is still terminally ill.
In practice, the conversation usually starts because a pattern has become hard to ignore. Repeated hospital stays, especially for the same condition, can mean an illness is no longer responding to treatment meant to cure it. Treatment that used to buy good weeks now costs more days than it gives back. If the drive, the waiting room and the recovery days take more from someone than the treatment returns, say so, gently, to the doctor who prescribed it.
The two things that have to be true together
A doctor’s certification of a terminal illness with 6 months or less to live, and the person’s own choice of comfort care instead of care to cure that illness. Neither half works alone. A serious prognosis by itself enrolls nobody, because the choice belongs to the person living it. And wanting hospice enrolls nobody without the certification.
The second half is the one that stops families in the doorway. It is a decision about direction, made by the person or by whoever is legally authorized to speak for them. It is not a form a family fills out to make things easier on themselves, and it can be undone.
Hospice is not a place
Hospice is care, and it goes where the person lives: their own bedroom, a daughter’s spare room, an assisted living apartment, a nursing home. The hum of an oxygen concentrator in the den. A hospital bed where the couch used to be. Most families expect a building and get a team at the door instead.
That team typically includes a physician, a nurse, a hospice aide, a social worker, a chaplain, volunteers and a bereavement specialist. The aide handles the physical care that is hardest to do for your own parent or spouse: bathing, hair, skin. The social worker takes on paperwork and the questions nobody knows who to ask. And a hospice nurse usually visits regularly, with someone available by phone 24 hours a day, seven days a week.
What are the four levels of hospice care?
People often search for the four stages of hospice. What they usually mean are the four levels of care Medicare pays for, and they are not stages anyone passes through in order. The team moves between them as needs change.
Routine home care
The everyday level, for when the person is not in crisis. Home might be a house, a skilled nursing facility or an assisted living facility. The team visits on a schedule, and the family carries the hours in between.
Continuous home care
For a crisis at home. It is available only during brief periods of crisis and only as needed to keep the person at home, so a hard night does not have to mean an ambulance.
General inpatient care
When pain or symptoms cannot be controlled where the person lives, care moves to an inpatient facility to get them settled. In St. Louis, Mercy’s de Greeff Hospice House lists inpatient hospice for patients who need short-term symptom management.
Respite care
Respite is for the caregiver, and nobody should feel guilty using it. The person stays in an approved inpatient facility for up to 5 consecutive days so the people doing the caring can sleep in their own bed, shower without listening for a call, or simply stop.
Familiar things still comfort people in a hospital bed, even a well-worn Blues jersey.
Can someone change their mind after choosing hospice?
Yes. A person has the right to stop hospice care at any time, and can restart it later if they are still eligible. Say that out loud at the family table, because someone there believes signing means the door locks. It does not.
You can also change providers. Under Medicare, a person has the right to change hospice providers once during each benefit period. Hospice is covered for two 90-day benefit periods, followed by an unlimited number of 60-day periods.
Why starting sooner gives a family more
Setup takes time. The equipment, the first visits, learning who to call at two in the morning and what to say when they answer, all of it takes a while to settle. A family that starts early gets a team that already knows the person’s face, their good hours and their bad ones. A family that starts in the last few days spends those days meeting strangers at the door.
Comfort is not a switch. It is a set of decisions the team keeps adjusting, and adjusting takes days. None of this is an argument for moving faster than you are ready to. It is an argument for having the conversation earlier than feels necessary, so the choice belongs to your family and not to a crisis at three in the morning.
What should you ask a hospice provider before you decide?
Ask more than one provider the same questions, then compare the answers side by side. Take these with you:
- Who comes to the house, how often, and how long is a visit?
- Who actually answers the phone at two in the morning?
- How quickly can someone get here when symptoms change suddenly?
- Which of the four levels of care do you provide, and where would inpatient care happen?
- What is the family expected to do between visits, honestly?
- What will we pay for, including room and board, and what is covered?
- What bereavement support continues afterward, and for how long?
Then ask one more and listen to how it is answered: what usually goes wrong, and how do you handle it? A team that answers that candidly has told you something real about how it works.
Where do you start in the St. Louis metro?
You are allowed to compare, and you are allowed to ask hard questions. Look through hospice providers across the metro on St Louis Near Me Directory, call two or three with the questions above, and bring someone with you on the call if you can. Two people hear more than one.
If you’re the hospice team, the home care agency or the equipment company families lean on in the hardest weeks, the next family is searching for you right now. List your organization on St Louis Near Me Directory so they find you, and get more customers from the people already searching nearby.
Frequently asked questions
Which two conditions must be present for a patient to enroll in hospice?
Under Medicare, the hospice doctor and the regular doctor, if there is one, certify that the person is terminally ill with a life expectancy of six months or less, and the person accepts comfort care instead of care to cure the illness. They also sign a statement choosing hospice. Neither half is enough alone. Your physician and the hospice team confirm whether a particular situation meets both.
What are the four stages of hospice?
Most people asking this mean the four levels of hospice care Medicare pays for: routine home care, continuous home care, general inpatient care and inpatient respite care. They are not stages anyone moves through in order. Routine home care is the everyday level. Continuous home care covers brief periods of crisis at home. General inpatient care handles symptoms that cannot be controlled where the person lives. Respite gives the caregiver a rest of up to 5 consecutive days.
What is the downside of hospice care?
Enrolling means choosing comfort care over treatment meant to cure the illness, and some people are not ready to make that trade. At the routine level the team visits rather than stays, so much of the daily presence falls to family. And under Medicare, room and board is not covered when hospice care happens at home or in a nursing home. A person can still stop hospice at any time and restart it later if eligible.
What hospice does not tell you?
Usually it is less hidden than unasked. Ask what you will pay for: under Medicare there is a copayment of up to $5 per prescription for pain and symptom drugs, and room and board is not covered at home or in a nursing home. Ask who answers at night. Ask what happens if symptoms cannot be controlled at home. And know that you can change hospice providers once during each benefit period.
How does a hospice nurse know when death is near?
Experienced hospice nurses read changes in a person over days rather than any single measurement, drawing on patterns they have watched many times. What nobody can give you is an exact time. If you want to know what the nurse is seeing, ask directly and ask them to be plain with you. They expect the question.
What organs shut down first in hospice?
There is no single answer that holds for everyone, because what happens in the body depends on the illness and the person. That is a real answer, not a dodge. The people who can describe what to expect in one specific case are the hospice nurse and the physician who know the diagnosis. Ask them. Knowing what is coming is usually less frightening than imagining it.
What time do most hospice patients pass away?
No article can give you a time, and anyone offering a confident one is guessing. If what you are really asking is how to be there, say exactly that to the hospice nurse. They can tell you what they are noticing and help you plan the practical parts around it. And if you step out for a moment and it happens then, that is not a failure on your part.
What is the painful truth about hospice care?
Usually it is not the care itself. It is what the care means: the goal has moved from cure to comfort, and a family is living through that. The practical truth is smaller and easier to fix: Medicare covers the hospice care, but not room and board at home or in a nursing home. Ask about it on the first call, so money is one less thing to carry.
Written by a dedicated team of St. Louis locals who live, work, and play right here in the St. Louis metro. Founder Lane Forman and team are committed to building the region’s most trusted directory by verifying listings and connecting local businesses with loyal customers across Missouri and Illinois.