When families begin to explore hospice, they often picture a single type of service. However, hospice care is not a one-size-fits-all solution. It is a dynamic and compassionate philosophy of care designed to adapt to the changing needs of patients and their loved ones. To ensure every person receives the right care at the right time, Medicare defines four distinct levels of hospice care. Understanding these levels can empower your family to make informed decisions and ensure your loved one’s journey is met with comfort, dignity, and the appropriate support.
Each level serves a unique purpose, from managing daily comfort at home to providing intensive support during a medical crisis. The ability to transition between these levels is a core strength of the Medicare hospice benefit, ensuring care remains personalized and responsive. This guide will walk you through Routine, Continuous, General Inpatient, and Respite care.
Routine Home Care: The Heart of Hospice
Routine Home Care (RHC) is the most common level of hospice service. In fact, according to the National Hospice and Palliative Care Organization, RHC accounts for over 95% of all hospice care days. This level of care is provided wherever the patient calls home—whether it’s a private residence, an assisted living facility, or a nursing home.
Under RHC, the patient receives regular, scheduled visits from their interdisciplinary hospice team, which may include a registered nurse, hospice aide, social worker, spiritual care coordinator, and volunteers. The focus is on expert pain and symptom management, personal care, and emotional and spiritual support for both the patient and their family. All medications, medical equipment, and supplies related to the terminal diagnosis are typically covered, ensuring comfort and quality of life are the top priorities.
Continuous Home Care: Managing a Crisis at Home
Sometimes, a patient experiences an acute medical crisis, such as uncontrolled pain, severe shortness of breath, or persistent nausea. When these symptoms require more intensive, skilled nursing care to be managed at home, Continuous Home Care (CHC) may be initiated. CHC provides short-term, round-the-clock nursing care in the patient’s home to bring the crisis under control.
As defined by the Centers for Medicare & Medicaid Services (CMS), this level requires a minimum of eight hours of care within a 24-hour period, with more than half of that care provided by a nurse (RN or LPN). The goal of CHC is to manage the acute symptoms so the patient can avoid a disruptive hospitalization and quickly return to the comfort of Routine Home Care.
General Inpatient Care: For Symptoms Needing a Higher Level of Skill
When a patient’s symptoms become too complex or severe to be managed at home, even with continuous care, General Inpatient Care (GIP) is available. This is a short-term level of care provided in a Medicare-certified facility, such as a hospital, a dedicated hospice inpatient unit, or a skilled nursing facility with which the hospice has a contract.
GIP is distinct from a standard hospital admission. Its sole purpose is aggressive, 24-hour symptom management that requires a clinical setting. Once the crisis is resolved and symptoms are stabilized, the patient is discharged back to their home setting under Routine Home Care. Due to its high cost, GIP is under increased regulatory scrutiny to ensure it is used appropriately for necessary, short-term interventions.
Inpatient Respite Care: Supporting the Caregiver
Hospice care extends beyond the patient to support the entire family. Inpatient Respite Care is a level of care designed specifically to provide a much-needed break for the primary caregiver. Caring for a loved one at the end of life is emotionally and physically demanding, and this benefit is designed to prevent caregiver burnout.
Under the Medicare hospice benefit, a patient can be temporarily admitted to a certified facility for up to five consecutive days. During this time, the hospice team continues to manage the patient’s care, allowing the caregiver to rest, recharge, and attend to their own needs, confident that their loved one is in a safe and supportive environment.
Seamless Transitions: How Care Levels Adapt to Your Needs
A patient’s needs are not static, and the four levels of care are designed to be fluid. A patient may start on Routine Home Care, require a brief period of Continuous or General Inpatient Care to manage a crisis, and then return to routine care once stabilized. The hospice interdisciplinary team is constantly assessing the patient’s condition and communicating with the family.
The decision to change levels of care is always made collaboratively between the hospice team, the patient, and the family. The goal is simple: to provide the most appropriate and effective care that honors the patient’s wishes and ensures comfort and dignity at every stage of their end-of-life journey.
Understanding which level of care is right for your loved one can feel overwhelming, but you don’t have to navigate it alone. If you have questions about which type of hospice care is most appropriate for your family’s situation, please call the compassionate team at ViaQuest Hospice at 855.289.1722.
You can also download our Complete Guide to Hospice Care for comprehensive information about the services and support available to patients and their families.
Key Takeaways
- Hospice care is not one-size-fits-all; it includes four distinct levels defined by Medicare to meet changing patient and family needs.
- Routine Home Care is the most common level, while Continuous and General Inpatient Care are reserved for short-term, acute symptom crises.
- Inpatient Respite Care is a vital benefit designed to support family caregivers by providing them with a temporary break.
