Hospice care is a holistic approach to caring for patients at the end of life, focusing on 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.1 What level of care a patient needs is based on the patient’s circumstances and what kind of services they need. This is one important way that hospice is able to quickly adjust to care needs, supporting patients and families during a time that can often feel scary and overwhelming.
These are the four levels of hospice care:
1. Routine Home Care
Routine home care (RHC) is the most common type of hospice care, with nearly 99% of hospice care provided under this level of care. 2 Routine home care is provided to patients in a comfortable and familiar environment 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.
2. Respite Care
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 provide and coordinate the plan of care and arranges transport for the patient to the facility and back after the stay as needed.
[action 1]
3. 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 nursing and aide care in a 24-hour period. The team will transition the patient back to routine home care if appropriate and the crisis is resolved.
4. 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 treatments are necessary, the hospice team will facilitate a transfer to a hospital, long-term care facility or hospice inpatient unit and continue providing and coordinating the plan of care.
Once 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 the hospice physician to determine the appropriate level of care. Each patient must meet the criteria 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.
What Are the Hospice Eligibility Criteria?
Regardless of level of care, patients must be eligible for hospice care to receive services under the Medicare hospice benefit. To meet hospice eligibility criteria, there are a few requirements:
- A doctor must certify that the person likely has six months or less to live, if the disease runs its normal course.
- The person must be willing to stop curative treatments and instead focus on treatments that improve comfort and quality of life
- The hospice provider must be Medicare-certified
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, psychosocial and spiritual needs.
Some hospice agencies also offer specialized programs. For example, Amedisys offers a unique dementia specialty program called Dementia Care Connect + for those living 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. To be changed to different levels of care, the patient must also meet the specific criteria for each level of care, as determined by the hospice physician. There are other options for paying for hospice care, including veteran’s benefits, private insurance and more.
What Services are Covered?
The Medicare hospice benefit includes several items and services: 3
- Nursing care
- Physical and occupational therapy
- Spiritual care
- Medical social worker services
- Dietary counseling
- Medical supplies and equipment
- Medications to manage pain and symptoms
- Bereavement counseling
- Hospice aide services
- Speech therapy
- Care from an approved physician (including nurse practitioners)
Refer a patient to hospice today via one of our easy options and a specialist is available to help.
Deb Gallaher, MBA, MSN, 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.
References |
