Table of Contents

This article is meant to help families as well as new hospice staff understand the four levels of care in hospice. There are several levels of care according to Medicare guidelines that govern in United States of America whether the patient is using Medicare or not.

Routine Care — the most usual form of hospice care is routine care. This is task-based care where a visiting nurse (LPN or RN) comes anywhere from once every literal 14-days to several times per week; and all visiting staff (, social worker, certified nursing assist, the nurses) are task-based such that they come to see the patient and family, complete a set of tasks and leave for the next patient until the end of their work day. Medicare guidelines are that for routine care the minimum visit time is 30 minutes. Most agencies have a maximum time for routine care as being two hours. There is leeway given in both directions such that a visit might be 15 to 20 minutes or could be three or four hours. It's based on the current needs of the patient and family.

() Care — This along with are the most misunderstood levels of care in hospice. care takes place in the hospital setting where the (1) patient has symptoms which can only be controlled in a hospital setting such as frequent monitoring for medication dose (strength), frequency, and effectiveness of the medications. (2) There is a goal to transition the patient from any IV or injectable medications to oral medications. (3) There's a plan in the works to discharge the patient from the hospital setting to a home setting which can include a facility (just not a hospital). Number three (3) is the most misunderstood even by hospital staff participating with GIP patients, but it is a Medicare requirement that the overall goal of GIP is to achieve a means of “at-home” symptom management. GIP requires the hospice agency to send out a nurse daily to work with the hospital staff to meet the GIP goals for the patient.

 — Continuous care is where hospice care is provided for eight hours or more during a 24-hour period for which the nurse (LPN, RN) is present for greater than 50% of the time. Continuous care is remarkably like such that there are Medicare rules for what qualifies for continuous care. Since hospice at home requires that the family, and I cannot stress this enough the family, is the primary caregiver for the patient — the situation must involve one that is in constant motion typically involving the titration of medication which means frequent changing of doses and potential frequent changes of what medications are used to control comfort. The most common case for continuous care (at home) in my experience is uncontrolled followed by uncontrolled pain. Once the nurse has achieved control of the symptoms and the medications and instructions for the family are in place, continuous care is ended, and routine care is resumed.

 — Where the patient is placed in a skilled facility within the operating area of the hospice (this may or may not be local to the family of the patient) with the first available bed for up to five days per benefit period. The family needs to supply the patient's medications and clothing.

Scheduled Visiting Frequencies as it relates to

  • Routine Care — daily if the patient is within two weeks of life or less or there are current symptoms that need once-a-day tweaks for a brief period of time. Otherwise based on the patient and family needs several times per week to every two weeks or less. Medicare's maximum spread is once every two weeks (a maximum of 14 days).
  • General Inpatient (GIP) — daily visits.
  • Continuous Care — on-site eight or more hours per day until symptoms resolved; a nurse must be present greater than 50% of the time.
  •  — same visit frequency as routine care based on the patient's needs, though at least one visit during the stay. It is quite common to get a “tuck in” visit or call the day the patient arrives and then another when the patient gets back home.

Always remember your hospice provider should be available 24×7 for phone calls including asking for any of the visiting staff to come sooner than “scheduled.”

Conclusion

The levels of care in hospice, as defined by Medicare, include routine home care, general inpatient care, continuous home care, and respite care. These levels of care are designed to meet the varying needs of patients and their families as they navigate the end-of-life journey. Routine care is the most common form of hospice care, involving task-based visits by a hospice team. General inpatient care takes place in a hospital setting and is aimed at managing symptoms that require frequent monitoring or transitioning the patient to at-home symptom management. Continuous care provides hospice care for eight or more hours during a 24-hour period, typically for uncontrolled symptoms that require constant attention. Respite care allows the patient to stay in a skilled facility for up to five days per benefit period, providing a short break for the family caregivers. It's important for families and caregivers to understand these levels of care to ensure that the patient's needs are met effectively throughout the hospice journey. Always remember that the hospice provider should be available 24×7 for phone calls, including asking for any of the visiting staff to come sooner than “scheduled”

Resources

Providing Comfort During the Last Days of Life with Barbara Karnes RN (YouTube Video)

Preparing the patient, family, and caregivers for a “Good Death”

Velocity of Changes in Condition as an Indicator of Approaching Death (often helpful to answer how soon? or when?)

The Dying Process and the End of Life

The Last Hours of Life

As an Amazon Associate, I earn from qualifying purchases. The amount generated from these “qualifying purchases” helps to maintain this site.

Gone from My Sight: The Dying Experience

The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Death

By Your Side , A Guide for Caring for the Dying at Home

As an Amazon Associate, I earn from qualifying purchases. The amount generated from these “qualifying purchases” helps to maintain this site.

The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease and Other Dementias

Dementia Home Care: How to Prepare Before, During, and After

The Dementia Caregiver's Survival Guide: An 11-Step Plan to Understand the Disease and How To Cope with Financial Challenges, Patient Aggression, and Depression Without Guilt, Overwhelm, or Burnout

Dementia Caregiving: A Self Help Book for Dementia Caregivers Offering Practical Coping Strategies and Support to Overcome Burnout, Increase Awareness, and Build Mental & Emotional Resilience

Navigating the Dementia Journey: A Compassionate Guide to Understanding, Supporting, and Living With Dementia

Ahead of Dementia: A Real-World, Upfront, Straightforward, Step-by-Step Guide for Family Caregivers

Four Common Mistakes by Caregivers of loved ones with Dementia and what do differently (video)

Oh hi there 👋 It's nice to meet you.

Sign up to receive updates on new articles to your inbox.

The emails we will send you only deal with educational articles, not requests to buy a single thing! Read our privacy policy for more information.

Share your love