Hospice care is a holistic approach to caring for patients at the end of life, treating the whole person by addressing their medical, emotional, social and spiritual needs. Care is tailored to each patient’s individual needs and circumstances.
In order to be certified by Medicare, all hospice agencies are required to provide four levels of hospice care. What level of care a patient needs is based on the patient’s circumstances and what kind of services they need.
These are the four levels of hospice care:
Routine Home Care
Routine home care is the most common type of hospice care, providing patients a comfortable and familiar environment for their final days wherever they call home. The interdisciplinary hospice team will conduct regular visits depending on the plan of care. Hospice team members, including the patient’s doctor, nurses, social workers and chaplains, are on call 24/7 for any needs.
The hospice team will also determine whether any special equipment or supplies are needed to support the patient and assist the family in obtaining the equipment and needed supplies.
Serving as a hospice patient’s caregiver can be very taxing. Respite care is available for up to five days/five nights when caregivers need a break. The patient will be admitted to a long-term care facility or other inpatient facility with 24-hour nursing available. The primary hospice team continues to coordinate the plan of care and helps transport the patient to the facility and back after the stay.
Continuous Home Care
Continuous home care offers a more intensive type of medical care for short-term urgent healthcare needs or symptom crises that can still feasibly be addressed at home. The hospice team provides at least eight hours of continuous care in a 24-hour period. Once the crisis is resolved, the team will transition the patient back to routine home care.
General Inpatient Care
Sometimes, pain and symptoms related to the patient’s terminal illness cannot be feasibly controlled at home. When significant medication adjustments or other stabilizing treatments are necessary, the hospice team will facilitate a transfer to a hospital, long-term care facility or hospice inpatient unit and continue coordinating the plan of care.
If the patient’s pain and symptoms are managed, the hospice team will help transfer the patient back home and return to providing routine home care.
Who Determines the Right Level of Hospice Care?
The hospice care team will first evaluate the patient and consult with their physician to determine the appropriate level of care. Each patient must meet the criteria or need for the assigned level of care based on Medicare regulations. The physician must provide the order for the appropriate level of care and the patient and representative must agree with the plan.
Throughout the course of care, the team will collaborate with the patient, family and caregivers, monitor the patient’s condition and pain/symptom management and recommend a change in level of care if needed.
Are the Same Services Available for All Levels?
Yes, regardless of the level of care, patients have access to the full spectrum of clinicians, including skilled nurses, hospice aides, social workers, chaplains, therapists and volunteer services. In all circumstances, hospice care focuses on pain control and symptom management while addressing the patient’s full medical, emotional, social and spiritual needs.
Some hospice agencies also offer specialized programs. For example, Amedisys offers a unique dementia specialty program for those with advanced dementia. Additionally, nearly all Amedisys care centers are certified in the We Honor Veterans program designed to treat veterans’ unique end-of-life needs like managing traumatic memories, chronic pain and depression.
Will Insurance Cover All Levels of Hospice Care?
Yes, Medicare and Medicaid generally cover all hospice care, including all four levels, assuming the patient meets the full eligibility requirements, including having a doctor-certified terminal illness and electing supportive treatments over curative treatments. There are other options for paying for hospice care, including veteran’s benefits, private insurance and more.