If you’re considering hospice care for a loved one, you may be wondering how much support you and your family can expect from a hospice company under the Medicare benefit. A common question is whether hospice care offers round-the-clock care in the home. The answer is there are four levels of care based on the needs and condition of your loved one and caregiver.
Understanding the Four Levels of Hospice Care
Answering the question of 24-hour support starts with an understanding of the different levels of hospice care that are provided based on the patient’s circumstances. All Medicare-certified hospice agencies are required to provide all four levels of care. 1
It’s important to note that patients can move between levels of care based on their status, caregiver needs, and whether comfort care can be feasibly provided in the home.
Routine Home Care
This is the most common type of hospice care, providing patients a comfortable and familiar experience wherever they call home. The hospice team conducts visits based on the plan of care, while the team is available 24/7 for emergent needs.
Respite Care
Hospice care is designed to support not just the patient, but the family and other caregivers as well. The respite care level is available when caregivers need a break. Patients can be admitted to a long-term care facility with 24-hour nursing for up to five days/five nights. The hospice team continues coordinating the plan of care and arranges transport for the patient to and from the facility.
Continuous Home Care
This crisis level of care offers a more intensive degree of medical care for pain or symptom crises that can still be managed at home. The hospice team provides at least eight hours of continuous care in a 24-hour period, returning the patient to routine home care once the crisis is resolved.
General Inpatient Care
When pain or symptoms related to the patient’s terminal illness can’t be feasibly controlled at home, the hospice team can facilitate a transfer to a hospital or long-term care facility contracted with the care center and continue coordinating the plan of care. Once symptoms are managed, the team returns the patient back home to receive routine home care.
Next, we’ll take deeper dives into the levels of care that can provide longer-term care and scenarios for each.
Examples of Respite Care Needs
Caring for a loved one undergoing hospice care can be taxing and overwhelming at times. That’s why the hospice benefit aims to support both the family and the patient.
Caregiver Burnout
If a primary caregiver has been providing care for the hospice patient for months, they may experience physical and emotional exhaustion, making it more difficult to provide the care they want for their loved one.
Respite care allows the caregiver to take a well-earned break and rejuvenate while the patient receives professional, supportive care in an inpatient facility. Respite care can provide the caregiver respite for up to five days/five nights or until they’re able to resume their caregiving duties.
Caregiver Temporarily Unavailable
If the primary caregiver has an urgent personal matter like a medical procedure or family emergency that requires their full attention, caring for their loved one may become impossible. Respite care can fill this gap in availability for up to five days/five nights or until they’re able to resume their caregiving duties.
What Does Continuous Home Care Include?
Continuous home care is intended for times of crisis when the patient’s condition requires more attention than routine home care can provide. In this level of care, the hospice team provides a minimum of eight hours of continuous care in a 24-hour period. 2
Scenario: Mr. Johnson is an 82-year-old patient with end-stage chronic obstructive pulmonary disease (COPD). He has been under routine home care for a few weeks, but recently developed severe respiratory distress despite using his prescribed inhalers and oxygen therapy. His symptoms are not improving and significantly impacting his quality of life.
In this case, Mr. Johnson may need continuous care to receive certain interventions like frequent nebulizer treatments, administration of medications to reduce anxiety and ease breathing.
When is General Inpatient Care Necessary?
General inpatient care (GIP) is recommended when the patient’s symptoms cannot be managed at home and/or the patient/caregiver do not want Continuous Home Care, or if CHC has not been able to relive the uncontrolled symptoms.
Scenario: Mrs. Smith is a 84-year-old patient with end-stage heart failure. She begins to experience acute respiratory distress and dyspnea, or shortness of breath, which are not responding to medications or interventions available at home. The hospice team recognizes that she may require inpatient care to provide intensive respiratory support, frequent monitoring and possible interventions which require the resources and expertise of an inpatient facility.
What Does Medicare Cover?
Medicare covers all levels of hospice care if the patient needs all eligibility requirements. 3 Included in these services are medications necessary for symptom management and pain relief related to the terminal illness, medical equipment like hospital beds and oxygen equipment, skilled care services from the interdisciplinary hospice team and support services from medical social workers, chaplains and even volunteers for companionship.
Because hospice care is supportive care, Medicare does not cover any curative treatments, prescription drugs or medical care not prescribed or provided by the medical team and unrelated to the hospice plan of care. Medicare will also not cover any room and board at an in-patient skilled facility or nursing home where the patient lives full time or emergency room transportation or care unless it is arranged by the hospice team or related to the terminal illness.
How Do I Get Started with Hospice Care?
Wherever you and your family are with the discussion on care plans and needs, Amedisys is here to help. You can complete our hospice care assessment quiz to help determine eligibility or connect with a hospice care specialist by completing the form below.
Deb Gallaher, MSN, MBA, RN, NE-BC, CHPN, is a Senior Hospice Clinical Education Specialist for Amedisys. She has 10 years of experience in hospice and is passionate about sharing her insights on high-quality care.
