What Should Seniors Know About Hospice Care Levels?
Medicare hospice provides four levels of care matched to patient needs at different times. Understanding these levels helps families know what to expect and ensures patients receive appropriate care intensity throughout their hospice journey.
Understanding Hospice Care Levels
Medicare defines four distinct levels of hospice care, each with different services and settings. Patients move between levels as their needs change. The hospice team determines appropriate level based on symptoms and circumstances.
Routine Home Care
Routine home care is the most common level, provided where the patient lives, whether private home, assisted living, or nursing facility. This level provides intermittent visits rather than continuous presence.
Services include regular visits from nurses, aides, social workers, and chaplains. Frequency depends on patient needs. Between visits, family provides care with hospice available by phone around the clock.
Medications, supplies, and equipment related to the terminal illness are provided. The hospice team manages symptoms and supports the family. This level serves patients whose symptoms are manageable with intermittent professional care.
Continuous Home Care
Continuous home care provides intensive nursing presence during periods of crisis. This level is used when symptoms become uncontrolled and require more than routine visits to manage.
Nursing care is provided for at least eight hours in a 24-hour period, with more than half being nursing care. This continuous presence manages symptoms until they stabilize.
Common reasons for continuous care include severe pain, respiratory distress, uncontrolled nausea, agitation, or other symptoms requiring constant attention. Once symptoms are controlled, patients typically return to routine care.
Continuous care is provided in the home setting. The goal is intensive symptom management without hospitalization. This level is temporary, not ongoing.
General Inpatient Care
General inpatient care provides short-term hospitalization for symptoms that cannot be managed at home. Patients are admitted to hospice inpatient units, hospitals, or skilled nursing facilities with hospice arrangements.
Inpatient care is for symptom management, not custodial care. Once symptoms are controlled, patients return home or to their usual residence. Length of stay is typically brief.
Inpatient care may also be used for procedures like palliative radiation that require facility settings. The goal remains comfort, not cure.
Respite Care
Respite care provides temporary inpatient care to relieve family caregivers. Patients are admitted to facilities for up to five consecutive days while caregivers rest.
Respite care recognizes that family caregiving is exhausting. Periodic breaks enable sustained caregiving. Families should use respite care without guilt when needed.
Medicare covers respite care in Medicare-certified facilities. Hospice continues to oversee care during respite stays.
How Levels Are Determined
The hospice team assesses patient needs and determines appropriate care level. Transitions between levels occur as conditions change. Families can discuss care level needs with the hospice team.
Understanding care levels helps families know what to request and what to expect. If symptoms worsen and routine care seems insufficient, discuss whether higher care levels are appropriate.
Getting Hospice Care
All Seniors Foundation provides all levels of hospice care matched to patient needs. Appropriate care intensity ensures comfort throughout the hospice journey. Contact us to learn more about our comprehensive hospice services.
