What Are the Four Levels of Hospice Care?

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Hospice nurse giving water to an elderly woman in hospice care.
Published:  June 19, 2023

Hospice care is for patients who have a life-threatening or terminal illness and their life expectancy is six months or less if their disease process runs its normal course. Hospice care providers that are Medicare-certified must offer four levels of hospice care, which are defined by the Centers for Medicare & Medicaid Services. 

Levels of Hospice Care

As a patient progresses in their end-of-life journey, their level of care may change to meet their clinical needs.  For example, a terminally ill patient may begin hospice care with routine home care and transition into continuous home care and general inpatient care as symptoms become more severe.

Routine Home Care 

Routine home care for hospice patients is covered by Medicare Part A. It is for patients who have symptoms that do not require around-the-clock management by members of a clinical care team. The services a patient may receive under routine home care include nursing care, spiritual support, emotional support, aide care for activities of daily living and personal care, occupational therapy, and physical therapy. The patient may also receive medical supplies and use of medical equipment related to care of the patient’s terminal diagnosis. 

Routine home care allows hospice patients to receive the support and medical care they need without leaving their home setting. This allows them to keep their daily routine as similar as possible while receiving hospice care. 

Continuous Home Care 

Continuous home care is at-home hospice care that offers temporary 24/7 support by the hospice care team. The type of primary services and equipment remain the same as with routine home care. However, continuous home care is designed for hospice ill patients who experience moderate to severe acute symptoms that require a higher level of management to achieve palliation or relief of symptoms. These symptoms may include, but are not limited to the following: 

  • Severe acute pain 
  • Nausea and vomiting
  • Severe anxiety 
  • High risk of seizures 
  • Difficulty breathing 

Although each provider may have a different process, continuous home care typically involves hospice workers taking shifts to ensure the patient and their family have the around-the-clock support they need while acute symptoms exist. The hospice care physician may also stay in more frequent communication with the patient’s primary care physician. 

General Inpatient Care 

General inpatient care is often provided temporarily for terminally ill patients who have symptoms that cannot be effectively managed at home. Inpatient care includes 24/7 monitoring by medical staff to supplement hospice services. 

Symptoms that often lead to a need for treatment in an inpatient facility are similar to the acute symptoms that require continuous home care, although they may be worse and require the need for more complex medical equipment and extensive monitoring by the hospice team. Some patients may enter inpatient care out of necessity due to their symptoms, but others may choose general inpatient care to ensure the fastest and most reliable treatment possible. 

Respite Care 

Respite care is offered when the primary caregiver is mentally or physically exhausted and needs a break or will be temporarily unavailable (e.g. while taking a short trip). With respite care, the patient checks into the inpatient facility, and their physical and emotional needs are met by the hospice staff. Respite care is limited to five days at a time. 

How to Determine the Level Needed 

To be eligible for hospice care, the patient’s doctor and the hospice care team must establish that the patient has a life expectancy of six months or less. 

In deciding which of the four levels of hospice care are most appropriate, the hospice team will examine the severity of the patient’s symptoms and the quality and amount of care they are able to receive at home and consider the preferences of the patient and their family. 

Contact The Hospice Care Experts 

We can answer any questions you may have about hospice care for yourself or for a loved one. We understand how stressful end-of-life care can be, and we are here to help. Click the button below to complete our Request Care form to learn more about how Traditions Health can help. 

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