What Are the Levels of Hospice Care?

Medicare Determines Hospice Care Level Definitions

hospice nurse helping male patient in bed
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Medicare defines four distinct levels of hospice care. This benefit provides goods and services to allow you and your family to stay together in the comfort of your home, unless you need care in an inpatient facility, for the duration of your terminal illness.

The patient is still responsible for the deductible and coinsurance amounts for expenses incurred due to health problems not related to the terminal illness.

Level 1 - Routine Home Care

Routine home care is the basic level of care under the hospice benefit. If a patient resides in a nursing home, it can also be called routine nursing home care, and includes:

  • Nursing services
  • Physician participation
  • Medical social services
  • Home health aide services
  • Counseling services (pastoral, spiritual, bereavement, dietary, and others)
  • Medications
  • Medical equipment
  • Medical supplies
  • Lab and diagnostic studies related to terminal diagnosis
  • Therapy services

Level 2 - Continuous Home Care

If you have continuous home care, a nurse and/or a home health aide will remain in the patient's home environment for 8 to 24 hours per day. Continuous care is a short-term level of care reevaluated every 24 hours. Some examples of symptoms requiring continuous care would be:

  • unrelieved pain
  • severe nausea and vomiting
  • severe shortness of breath
  • anxiety or panic attacks
  • a breakdown in the primary caregiver support system

    Level 3 - General Inpatient Care

    Some patients have short-term symptoms so severe they cannot get adequate treatment at home or they may feel more comfortable getting treatment at an inpatient facility.

    Symptoms requiring inpatient care are the same as those requiring continuous care (above), only the setting of care may be different.

    With inpatient care, nurses are available around the clock to administer medications, treatments, and emotional support to make the patient more comfortable. There are several types of facilities that offer inpatient hospice services:

    • A free-standing facility owned and operated by a hospice company.
    • A hospital may have a unit to provide inpatient hospice care.
    • Long term care facility may lease a unit in a nursing home to a hospice company.

    Level 4 - Respite Care

    Respite care services are more for the family than for the patient. If the patient does not meet criteria to qualify them for continuous care or inpatient care but the family is having a difficult time, respite care may be an option.

    If a patient’s family is the primary source of care and cannot meet their needs due to caregiver stress or other extenuating circumstances, a patient may temporarily be admitted to an inpatient environment to give the family a needed break or respite. There is a five-day limit on respite care. Once that period expires, the patient is discharged and returns home.

    Determining Level of Care

    A facility admits patients to hospice on any level of care necessary at that time. The facility can transfer the patients between levels of care as their needs change. The decision to treat someone at a higher level of care falls to the hospice physician, who documents this information. With four levels of care in place, no patient should ever be left in a crisis situation alone.

    Source: Department of Health and Human Services: Hospice Payment System (2015)

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