We understand that navigating hospice care can be overwhelming, especially when faced with terms like “inpatient” and “GIP.” This article is here to help you understand these concepts better.
Purpose of the Article
Our goal is to clarify the difference between two types of hospice care:
Hospice General Inpatient (GIP) care at a hospital
Inpatient care at a hospice facility that’s not at the GIP level
We emphasize that “inpatient” doesn’t always mean GIP care. By the end of this article, you’ll have a clearer understanding of these options, which will help you make informed decisions for your loved one.
Importance of Understanding Different Levels of Hospice Care
Knowing the differences between care levels is crucial because:
It affects the type of care your loved one receives
It impacts where your loved one will stay
It influences insurance coverage and potential out-of-pocket costs
It helps you communicate more effectively with healthcare providers
It empowers you to advocate for the best care for your loved one
Understanding these differences can be life-changing for both the patient and the family. It ensures that your loved one receives the most appropriate care for their needs, whether intensive symptom management in a hospital setting or comfort-focused care in a hospice facility.
Care Type
Location
Level of Care
Typical Duration
GIP
Hospital
Intensive
Short-term (days to weeks)
Inpatient Hospice
Hospice Facility
Comfort-focused
Variable (days to months)
Every patient’s journey is unique; what works best for one person may not be ideal for another. That’s why it’s so important to understand all your options.
In the following sections, we’ll explore each type of care more fully, helping you understand when each is appropriate and what you can expect. We aim to support you in making the best decisions for your loved one during this challenging time.
What is Hospice General Inpatient Care (GIP)?
Overview of GIP
Definition and Purpose
Hospice General Inpatient Care (GIP) is a special type of hospice care provided in an inpatient setting, such as a hospital or a hospice facility. It is designed for patients who need short-term, intensive care to manage severe symptoms that cannot be controlled at home.
Typical Settings for GIP Care
GIP care can be provided in the following ways:
Medicare-certified hospice inpatient units
Medicare-certified hospitals
Medicare-certified skilled nursing facilities (though less common)
Eligibility Criteria for GIP
Clinical Conditions Requiring GIP
Patients qualify for GIP when they have severe symptoms that can’t be managed in other settings. Some examples include:
Uncontrolled pain that needs frequent medication adjustments
To qualify for GIP, the following must be documented:
A precipitating event: Onset of uncontrolled symptoms or pain.
Interventions tried at home: Documentation that home-based interventions were unsuccessful.
Daily documentation: Justification for the need for GIP care each day.
Important Note: GIP is not appropriate for:
Solely for imminent death
Unsafe living conditions at home
Caregiver respite or lack of a caregiver
Situations where symptoms have already been controlled
Benefits of GIP
Symptom Management
GIP provides intensive symptom management for conditions that require:
Frequent evaluation and reassessment by healthcare professionals
Aggressive pain management
Complicated medication delivery
Short-Term Intensive Care
GIP is intended for short-term care to stabilize acute symptoms. The goal is to manage the patient’s symptoms effectively and then transition them back to less intensive care, such as routine home hospice care.
Aspect
GIP Care
Setting
Inpatient (hospital, hospice unit, skilled nursing facility)
Purpose
Manage severe symptoms
Duration
Short-term (days to weeks)
Eligibility
Severe, uncontrolled symptoms
Documentation
Daily justification required
By understanding the purpose, settings, eligibility, and benefits of GIP, you can better advocate for the care your loved one needs. Always consult with healthcare providers to ensure the best possible care plan is in place.
Hospice Inpatient Care at a Facility
When your loved one needs more support than can be provided at home but doesn’t require the intensive care of GIP, facility-based inpatient hospice care can be an excellent option. Let’s explore what this means for you and your family.
Differences from GIP Care
Level of Care and Intensity
Facility-based inpatient hospice care differs from GIP in several key ways:
Less intensive: While still providing 24/7 care, it’s less medically intensive than GIP.
Longer-term: Patients can stay for extended periods, unlike the short-term nature of GIP.
Focus on comfort: The primary goal is to maintain comfort rather than manage acute symptoms.
Typical Settings and Services Provided
Facility-based inpatient hospice care is usually provided in the following ways:
Dedicated hospice facilities
Nursing homes with hospice units
Assisted living facilities with hospice partnerships
Services typically include:
24-hour nursing care
Pain and symptom management
Personal care (bathing, dressing, etc.)
Emotional and spiritual support
Social services
Volunteer visits
Eligibility Criteria for Facility-Based Inpatient Care
Conditions That Do Not Require GIP
Patients may be eligible for facility-based inpatient care when they:
Need more support than can be provided at home
Don’t have acute symptoms requiring intensive medical intervention
Have a prognosis of six months or less if the illness follows its normal course
Typical Scenarios for Facility-Based Care
Common situations where facility-based care is appropriate include:
When caregivers need extended respite
If the home environment isn’t suitable for hospice care
When the patient prefers a facility setting
If the patient needs more care than can be safely provided at home but doesn’t require GIP
Benefits of Facility-Based Inpatient Care
Continuous Support
Facility-based care offers several advantages:
Round-the-clock care: Trained staff are available 24/7 to address needs and concerns.
Professional oversight: Regular assessments ensure comfort and symptom management.
Caregiver relief: Family members can focus on spending quality time with their loved ones.
Comfort and Holistic Approaches
Facility-based care emphasizes:
Personalized care plans: Tailored to each patient’s unique needs and preferences.
Holistic support: Addressing physical, emotional, and spiritual needs.
Peaceful environment: Designed to promote relaxation and comfort.
Aspect
GIP Care
Facility-Based Inpatient Care
Duration
Short-term (days to weeks)
Can be long-term
Intensity
High (acute symptom management)
Moderate (ongoing comfort care)
Setting
Hospital or specialized unit
Hospice facility or nursing home
Focus
Managing severe symptoms
Maintaining comfort and quality of life
Eligibility
Acute, uncontrolled symptoms
Need for ongoing support beyond home care
Remember, facility-based inpatient hospice care aims to provide a comforting, supportive environment when home care isn’t feasible. It offers peace of mind for families and ensures that your loved one receives compassionate, professional care around the clock. Always discuss your options with your hospice team to determine the best care plan tailored to your specific situation.
Key Considerations for Families and Caregivers
Several factors must be considered when deciding between different types of hospice care to ensure your loved one receives the best possible care. Here, we will discuss when to choose General Inpatient (GIP) care over facility-based inpatient care and provide questions to ask healthcare providers to make an informed decision.
When to Choose GIP over Facility-Based Care
Decision-Making Factors
Choosing between GIP and facility-based care depends on several factors:
Severity of Symptoms: If your loved one has severe symptoms that cannot be managed at home or in a less intensive setting, GIP may be necessary.
Duration of Care Needed: GIP is typically short-term and aimed at stabilizing acute symptoms, while facility-based care can be longer-term.
Caregiver Availability: If caregivers are unable to provide the necessary level of care at home, GIP may be a better option.
Patient’s Preferences: Consider your loved one’s wishes regarding their care setting and level of care.
Examples of Situations Requiring GIP
Here are some scenarios where GIP care is appropriate:
Uncontrolled Pain: Your loved one is experiencing severe pain that requires frequent adjustments to medication.
Severe Nausea and Vomiting: Persistent nausea and vomiting that cannot be managed at home.
Respiratory Distress: Difficulty breathing that needs continuous medical supervision.
Advanced Wounds: Complex wounds that need frequent and intensive treatment.
Agitated Delirium: Severe confusion or agitation that poses a risk to the patient or others.
Aspect
GIP Care
Facility-Based Inpatient Care
Duration
Short-term (days to weeks)
Can be long-term
Intensity
High (acute symptom management)
Moderate (ongoing comfort care)
Setting
Hospital or specialized unit
Hospice facility or nursing home
Focus
Managing severe symptoms
Maintaining comfort and quality of life
Eligibility
Acute, uncontrolled symptoms
Need for ongoing support beyond home care
Questions to Ask the Healthcare Provider
When discussing care options with healthcare providers, asking the right questions is crucial to understanding the care levels and ensuring they meet your loved one’s needs.
Clarifying Care Levels
What are the differences between GIP and facility-based inpatient care?
How do you determine which level of care your loved one needs?
Can you provide examples of situations where each type of care is appropriate?
Understanding Patient Needs and Preferences
What specific symptoms or conditions would require GIP care for my loved one?
How will you manage my loved one’s pain and other symptoms in each care setting?
What are the typical lengths of stay for GIP and facility-based inpatient care?
How will you involve my loved one and our family in care decisions?
What support services are available for family members in each care setting?
Question
Why It’s Important
What are the differences between GIP and facility-based inpatient care?
It helps you understand the intensity and focus of each care type.
How do you determine which level of care your loved one needs?
Ensures the care plan is tailored to your loved one’s specific needs.
Can you provide examples of situations where each type of care is appropriate?
Clarifies when each care type is most beneficial.
What specific symptoms or conditions would require GIP care for my loved one?
Identifies the triggers for more intensive care.
How will you manage my loved one’s pain and other symptoms in each care setting?
Ensures effective symptom management strategies are in place.
What are the typical lengths of stay for GIP and facility-based inpatient care?
It helps plan for the duration of care.
How will you involve my loved one and our family in care decisions?
Promotes family involvement and respects patient preferences.
What support services are available for family members in each care setting?
Ensures you have the necessary support during this time.
By asking these questions and considering these factors, you can make a more informed decision about the best care setting for your loved one. Remember, the goal is to provide the most appropriate and compassionate care to ensure comfort and quality of life.
Conclusion
As we conclude this discussion on hospice care options, we want to ensure that you feel empowered and informed about the choices available for your loved one. Let’s recap the key points and encourage you to take the following steps in your caregiving journey.
Recap of Key Points
Understanding “Inpatient” Care:
“Inpatient” doesn’t always mean General Inpatient (GIP) care.
There are different levels of inpatient hospice care, each serving unique needs.
General Inpatient (GIP) Care:
Purpose: For short-term, intensive symptom management
Setting: Typically in hospitals or specialized hospice units
When it’s needed: For severe, uncontrolled symptoms that can’t be managed at home
Facility-Based Inpatient Care:
Purpose: For ongoing comfort care when home care isn’t feasible
Setting: Often in dedicated hospice facilities or nursing homes
When it’s appropriate: For patients needing more support than home care can provide but not requiring GIP-level care
Key Differences:
Aspect
GIP Care
Facility-Based Inpatient Care
Duration
Short-term
Can be long-term
Intensity
High
Moderate
Focus
Acute symptom management
Ongoing comfort and support
Decision-Making Factors:
Severity of symptoms
Duration of care needed
Caregiver availability
Patient preferences
Encouragement to Discuss Options with Healthcare Providers
Your next steps are crucial in ensuring the best care for your loved one:
Reach out to your hospice team: They are your partners in this journey and can provide personalized guidance.
Ask questions: Use the provided questions as a starting point for discussions with healthcare providers.
Share your concerns: Be open about your worries and challenges. Your hospice team is there to support you, too.
Involve your loved one: Include them in discussions about their care preferences if possible.
Take time to reflect: This is a big decision. It’s okay to take some time to process the information and options.
Remember, you’re not alone in this journey. Your hospice team is there to support you every step of the way. They understand your challenges and are committed to providing the best possible care for your loved one.
Your role as a caregiver is invaluable. By seeking to understand the different care options available, you’re taking an essential step in advocating for your loved one’s comfort and quality of life.
Trust your instincts and communicate openly with your healthcare providers. Together, you can create a care plan that honors your loved one’s wishes and provides the support you all need during this time.
We hope this information has helped clarify the differences between GIP and other forms of inpatient hospice care. Remember, every situation is unique, and the best choice is to meet your loved one’s specific needs and align with their wishes.
You’re doing a wonderful job of caring for your loved one. Keep asking questions, seeking support, and taking care of yourself too. Your well-being is just as important as you navigate this challenging but meaningful journey.
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Currently, there is no universal director of end-of-life doulas (EOLD). It’s essential to note that some EOLDs listed in directories may no longer be practicing. The author recommends starting with IDLM, as their training program is always current and thorough, followed by NEDA, which is the only independent organization not affiliated with any school.
