Levels of Hospice Care

Hospice care can be given at different levels and in different settings. These depend on your needs. Learning about these levels can help you and your caregivers know what to expect and plan for the care you can receive.

What are the four levels of hospice care?

There are four levels of hospice care. These levels are based on the Medicare Hospice Benefit and the type of care needed. Most insurances follow Medicare’s guidelines.

The four levels of care are:

• Routine home care
• Continuous home care
• General inpatient care
• Respite care

Routine home care

Hospice care is most often given where you live. This may be your home, nursing home, skilled nursing facility (SNF), or assisted living facility (ALF).

When you receive home hospice care, your hospice nurse will visit you regularly. If you need help in between visits, someone is always available by phone 24 hours a day, 7 days a week. Other members of the hospice team may also visit depending on your needs.

In the home, your caregiver will be responsible for all other care. If you are in a facility, the facility staff may help provide some of the physical care you need. What they provide will depend on the type of facility and insurance coverage for hospice services.

How is home hospice arranged?

Once the decision has been made to start hospice care, a hospice team member visits you. During this visit, they will create a care plan with help from you and your caregivers. Then the hospice team will arrange any services that you need.

Hospice nurses make regular visits to see how you’re feeling and check on your needs. This allows them to make updates to your care plan and to address care needs as they change.

Hospice care can handle needs or concerns at any time. Home hospice programs have a nurse available by phone at all times. They can make home visits or send out other team members as needed between scheduled visits. Medicare-certified hospices must have doctors, nurses, and pharmacy services available 24 hours a day. Talk to your hospice about how they manage specific needs outside of regular business hours.

If an emergency happens while you are receiving hospice care at home, call hospice first. They can help you decide what to do. They will help arrange next steps, such as calling 911, if needed.

If a person in hospice goes to the hospital or emergency room (ER) without contacting hospice first, their hospice benefits might be at risk, and they may be asked to pay for the visit or hospital stay.

Continuous home care (CHC)

If your symptoms or health are changing significantly, or if you’re going through a health crisis and want to stay in your home, CHC may be an option. It can only be provided in a home, assisted living facility, or non-skilled long-term facility.

With this type of care, at least 8 hours of direct care must be provided by hospice in a 24-hour period. Most of the care must be provided by a nurse, but care provided by other team members, such as a hospice aid, will count.

To be eligible for CHC, you must:

• Need a nurse to monitor severe symptoms and clinical changes
• Need a nurse to give medications or treatments
• Want to avoid going to the hospital or inpatient hospice facility

Once you are stable or symptoms have improved, you can transition back to your regular hospice care service. If you need more intense care, you will transition to general inpatient care.

Talk to your hospice to see if this is an option they provide.

General inpatient care (GIP)

GIP care provides intensive hospice care in a setting other than your home. A person who needs GIP care may have needs that include:

• Pain management requiring IV medicines
• Frequent doses of IV medicines
• Continuous, 24-hour monitoring by nursing staff
• Uncontrolled symptoms that cannot be managed at home

GIP care is usually given in an inpatient hospice unit (IPU). This unit may be a free-standing hospice facility owned by your hospice program. Or it may be in a hospital or skilled nursing facility. You cannot receive this care in other locations.

GIP care is usually given for 5 days or less. Once symptoms are well controlled, you can return to your previous hospice service.

Respite care

Respite care is temporary and gives the primary caregiver time to rest or take care of other needs. This allows caregivers to focus on their own care needs while knowing their loved one is being cared for.

Respite care is usually given in a hospice facility or in a specific area reserved for respite care in nursing homes or hospitals. It can last up to 5 days. After the respite, the person with cancer will return home with their caregiver and usual hospice team.

Questions to ask a potential hospice team

Even if you plan to get hospice care at home, you might need inpatient or respite care at some point. You might want to ask your potential hospice provider these questions before making a decision.

Questions about care

• Does your hospice provide continuous home care if needed?
• Does your hospice provide inpatient or respite care? If so, where is it provided?
• Which hospitals or nursing homes work with the hospice for inpatient care?
• What kind of follow-up does the hospice provide for inpatient stays?
• Does the hospice provide nursing, social work, and aide care during respite care or an inpatient stay?

Questions about benefits

• How long can I stay in a hospital before it affects my hospice benefits?
• What happens if I no longer need inpatient care but cannot go home?
• How often can I get respite care?