What are the Different Levels of Hospice Care?

Table of contents

• What is hospice care?
• What are the different levels of hospice care?
• Who decides the level of care?
• How do I access hospice care?

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Hospice is a special type of care that provides comfort, support, and dignity at the end of life. In the United States, Medicare governs the provision of hospice care and pays for 80% of all hospice care. 

Many people mistakenly think that hospice is a place where your loved one goes. However, it’s actually an expert service that comes to your loved one wherever they are to relieve pain and keep them comfortable so they can enjoy a good quality of life for as long as possible.

Most families and even some clinicians also might not be aware that there are multiple types of hospice. In fact, there are four different levels of hospice care designed to meet the diverse needs of patients and their families.

What is hospice care?

Hospice care is end-of-life healthcare provided to someone who has a life expectancy of six months or less and has decided to no longer try to cure their illness. 

You might also hear this type of care called “comfort care.”

In hospice care, the goal is to help those at the end of their lives have peace, dignity, and comfort. To accomplish this, a team of healthcare professionals and volunteers work together to provide medical, emotional, and spiritual support. Additionally, families may receive support from the hospice team as well.

A comprehensive hospice program cares for all the needs of a patient and their family with the help of a team of experts. These experts include:

• A hospice board-certified physician
• Nurse practitioners
• Hospice trained nurses
• Social worker
• Spiritual support counselor 
• Certified home health aides 
• Volunteers

The Centers for Medicare and Medicaid Services (CMS) has defined four different levels of hospice care that every Medicare-certified hospice provider must provide. Each level of care meets a specific set of needs. Consequently, patients may experience one or all of the hospice levels throughout their hospice journey.

What are the different levels of hospice care?

Medicare-certified hospice providers are required to offer four different levels of hospice care. These are routine, continuous, inpatient, and respite care. The level of care that each patient receives depends on their needs and preferences. It can also change as the patient’s needs change.

Level 1: Routine hospice care at home 

Routine hospice care is the most common type of hospice service provided in the United States. In fact, according to the National Hospice and Palliative Care Organization (NHPCO), more than 90 percent of hospice care falls within this level. 

An interdisciplinary hospice team provides regularly scheduled services where the patient lives to help them maintain the best quality of life possible. The patient could live in a private home, an assisted living facility, a board and care home, or a long-term care facility.

Routine hospice care tailors services to the patient’s specific needs. Some patients spend their entire time in hospice in routine care, while others may need to transition to a different level of care as their symptoms worsen.

Support services can include:

• Home medical equipment
• Medications for pain and comfort
• Medical social services
• Spiritual support
• Volunteer visits
• Bereavement counseling
• Supplies related to the hospice diagnosis

Patients can still receive unscheduled visits between their routine visits when needed. 

Level 2: Continuous hospice care

Continuous hospice is care that a hospice patient receives during times of crisis. This crisis could be:

• Unrelieved pain
• Severe anxiety
• Breathing problems
• Other serious medical symptoms

During continuous care, patients receive hospice services for eight to 24 hours per day. At least half of this care is provided by a nurse who remains in the patient’s home during the day and possibly overnight to give treatments. 

The nurse is in close communication with a doctor. Together the hospice team works to manage the crisis symptoms and help the patient avoid needing to be admitted to a hospital.

The goal of continuous hospice care is intensive support to help the patient and their family return to routine hospice care. Alternatively, patients and their families may decide that transitioning to an inpatient hospice facility is best. 

Level 3: Inpatient hospice care

If your loved one has symptoms that can’t be managed at home, they can be admitted to inpatient hospice care. This can be performed in various settings, such as a dedicated inpatient hospice facility or contracted beds in a hospital or nursing home.

During inpatient hospice, patients receive around-the-clock intensive nursing care and support. Doctors can often prescribe more aggressive treatments to control symptoms than those provided at home.

Patients remain in inpatient hospice care for as long as is required to control their symptoms. However, the goal of inpatient hospice care is to stabilize the patient so they can return home to routine or continuous hospice care. 

Medicare covers the cost of transporting patients to and from inpatient hospice care.

Level 4: Respite care

Unlike the other levels of hospice care, respite care is mainly for the benefit of the patient’s caregivers. It helps caregivers avoid burnout and provide care more efficiently.

Family members or caregivers can ask for respite care when they need time off. During this time, a hospice patient may be admitted to a Medicare-certified inpatient hospice setting for up to five consecutive days. Medicare will pay for transport to and from home.

During respite care, families can still visit and be involved in the care of their loved one. However, they also have the opportunity to:

• Tend to their own healthcare needs
• Travel out of the area
• Attend important events
• Spend time at work
• Rest and recover

Who decides the level of care?

Assessment by a hospice care team is the best way to determine which level of hospice care is right for your loved one. They will take into account the patient and family’s current medical, emotional, and spiritual needs.

The hospice care team will also take into account the patient and family’s preferences. Some patients will prefer to have their hospice care in the comfort and privacy of their own homes. Others may feel more comfortable knowing they have 24/7 support from professional staff. 

Patients using Medicare hospice benefits may be admitted into a hospice program at any level of care as determined by their needs. They can also transfer between different levels of hospice care as needed.

How do I access hospice care?

When the time comes to engage hospice care for your loved one, there’s no need for you to be alone. Parentis Health Hospice can be with you every step of the journey to help your loved one through the end of life.

We offer all four levels of hospice care to assist with managing physical symptoms, emotional distress, and more. We’ll be with you, doing all we can to make sure your loved one is comfortable and that this precious time together can be cherished by your family.

Contact us today for more information on the different levels of hospice that Parentis Health Hospice can provide.