Medicare defines four levels of hospice care: routine home care, continuous home care, inpatient respite care and general inpatient care. Every Medicare-certified hospice must be able to provide all four, and the level can change as the patient’s needs change.
1. Routine home care
This is the most common level. The patient lives at home, in a family member’s home, in assisted living or in a nursing home, and the hospice team visits on a schedule. Nurses, aides, social workers and chaplains come as the plan of care requires, and a nurse is available by phone 24 hours a day.
Good to know: routine home care does not include round-the-clock caregivers. Family or paid caregivers provide most day-to-day care, with training and support from the hospice.
2. Continuous home care
When a patient has a crisis, such as severe pain, breathing difficulty or agitation, the hospice can provide mostly nursing care at home for extended periods (at least eight hours in a 24-hour day) until the symptoms are under control. The goal is to avoid a hospital stay.
Continuous care is short-term. Once the crisis passes, care returns to routine home care.
3. Inpatient respite care
Caring for someone at the end of life is exhausting. Respite care gives the family caregiver a break by moving the patient to a Medicare-approved facility, such as a hospice inpatient unit, hospital or nursing home, for a short stay. Medicare typically allows up to five days at a time.
Respite care is the one level where you may pay a small amount: 5% of the Medicare-approved cost. Ask your hospice how often respite can be arranged.
4. General inpatient care
When pain or symptoms cannot be managed at home, even with extra support, the hospice can move the patient to an inpatient setting such as a hospice unit, hospital or skilled nursing facility. Care is provided around the clock until symptoms are controlled, and then the patient can usually return home.
How the level is decided
The hospice team decides the level of care based on the patient’s needs, working with the patient and family. Families can always ask, “Would continuous care or inpatient care help right now?” if symptoms are getting worse or caregivers cannot keep up.
Questions to ask a hospice about levels of care
- “Have you provided continuous home care in the last year? How quickly can you start it?”
- “Where do your patients go for inpatient or respite care near us?”
- “How do I request respite care, and how much notice do you need?”
A hospice that never provides continuous care or inpatient care may not be equipped for a crisis. See more in how to choose a hospice.
Sources
This guide is general information, not medical advice.