There are four levels of hospice care: Routine Home Care, Continuous Home Care, General Inpatient Care, and Respite Care. Hospice patients often move from one level of care to another based on their current needs, symptoms, pain levels, and caregiver’s needs.
With four levels of care, each patient is able to receive the exact care that they need in the moment. This provides peace of mind for families who do not carry the burden of determining next steps, especially when the situation can change so quickly. Our hospice care team handles selecting the level of care that your loved one needs.
Routine Home Care
Routine Home Care, or Level One hospice care, involves a basic range of services. The team's focus is to give the patient end-of-life comfort wherever the patient calls home, whether that's in their house (or a family member's house), assisted living facility, skilled nursing facility, or board and care facility.
The hospice care team includes skilled nurses, certified hospice aides, physician, medical social services, spiritual support, volunteer support, and bereavement counseling. While all of these roles provide services as the patient needs them, the nursing team is available 24/7. Services often include visits from the members of the care team, medication, durable medical equipment, and supplies needed for medical care and keeping the patient comfortable.
Respite care is offered to provide a short-term break for caregivers in order to avoid burnout. Looking after an ill or disabled patient is a round-the-clock job that can feel overwhelming at times. This is why respite care is so important. It offers unpaid caregivers, often family members, the opportunity to rest and tend to their own personal needs.
Patients are transferred to a Medicare-certified skilled nursing care facility for up to five consecutive days (per billing period). The patent will receive the same level of care that they are provided with outside of respite care.
Continuous Care, or Level Two hospice care, is provided at the patient's home in times of crisis when a higher level of nursing care is temporarily needed. The goal is to manage severe symptoms and prevent hospitalization from being necessary. With this kind of care, the patient receives care from a nurse in their home for a longer period of time than any other level of hospice care. Continuous Care is provided for no less than eight hours in a 24-hour period, and at least 51% of that care is provided by a skilled nurse at bedside.
During Continuous Care, the nurse is monitoring symptoms, consulting with the doctor, and constantly changing the treatment approach in order to make the patient comfortable. Once the patient is comfortable for the long-term, they are moved to a different level of hospice care.
Crises that may result in a move to the Continuous Care level include:
- Severe nausea or vomiting
- Severe breathing problems or shortness of breath
- Severe pain that will no go away, and is not relieved with current interventions
- Terminal agitation or severe anxiety
A breakdown in the family or caregiver support system may also be considered a crisis. For example, a sudden and complete mental breakdown of the patient's primary caregiver, leaving the patient on their own, may warrant Continuous Care.
General Inpatient Care (GIP), or Level Three hospice care, shares some similarities with Continuous Care. Patients are moved to this level of care when they are experiencing a crisis and require a higher level of nursing care. Unlike Continuous Care, which is provided at home, Inpatient Care is provided for patients who are currently in a skilled nursing facility.
Examples of crises warranting Inpatient Care include:
- Unmanageable severe pain
- Severe anxiety
- Breathing problems or shortness of breath
- Extreme nausea or vomiting
- A severe breakdown of the primary caregiver, such as an actively grieving family member who does not want the patient to pass at home
If the patient is not already at a skilled nursing facility and is currently at home, the patient can be moved to a skilled setting on General Inpatient Care if the symptoms are not able to be managed at home. Once the patient is comfortable, they can be returned to the Routine Care level.