The decision to enroll in hospice care is one that involves many emotions and questions. If you or a loved one is considering hospice care, it is important to understand the key details of where hospice care will take place.
Often, when people think of hospice care they think of a place. But hospice is a type of care, not a location. The benefits of hospice care include improved quality of life and comfort, support and resources for patients who have a life expectancy of six months or less.
Hospice care is provided wherever a patient calls home, which could be their residence, the home of a loved one, a skilled nursing facility or another location. Sometimes, types of inpatient hospice care can be provided based on patient and caregiver needs and resources. What are the differences between inpatient care levels and hospice care that is provided in the home? Let’s discuss several important facts.
How is Hospice Care Delivered at Home?
Wherever home is, your hospice care team will visit you regularly to monitor your symptoms and plan of care to make sure you are receiving the right treatment and support. Hospice services at home include:
- Nursing care
- Help with bathing, dressing and grooming from a home health aide
- Medications, medical supplies and equipment related to the hospice diagnosis
- Help with errands and companionship from a volunteer
- Short-term inpatient care to manage pain and symptoms, if needed
- Short-term respite care to give caregivers a break
- Dietary counseling
- Bereavement support
- Advice and support for family and caregivers
These services are delivered to you in your home, and your hospice team is on-call 24/7 for any needs that may arise unexpectedly in addition to regular visits.
What is Inpatient Hospice Care?
While enrolled in hospice care, Medicare provides four different levels of hospice care. Two levels of care that involve home hospice (routine care and continuous home care) are provided in the patient’s home. The remaining two levels of care (respite care and general inpatient care) are provided short-term in an inpatient setting, based on patient and caregiver needs.
If general inpatient hospice care is deemed necessary by the hospice team or if respite care is needed, the patient will be transferred to a facility to receive the appropriate care. Respite and general inpatient hospice includes the same types of services as when the patient is at home, including pain and symptom management. You receive this type of care either as a patient in the hospital, inpatient hospice facility, or another facility such as a nursing home.
What Are the Differences Between Inpatient and Home Hospice?
There are some important differences between receiving hospice care in the home and under respite or general inpatient care, aside from just the physical location. Let’s take a closer look:
1. Respite and general inpatient hospice is temporary
If a patient’s hospice team determines that inpatient care is appropriate, the following levels of care may apply:
- Respite care - During respite care, the patient stays in an approved facility for up to 5 consecutive days and nights, so that home caregivers can rest or attend to other responsibilities. On day 6 the patient is returned to routine care. 1
- General inpatient hospice care - In general inpatient care, the patient is transferred to an approved facility and receives treatment for symptoms that were unable to be managed at home. This level of care is appropriate in a crisis, where even continuous care at home by the hospice team is not enough to manage pain or other symptoms. Hospice provides and coordinates care with the facility and when the symptoms are managed, the patient returns home. 2
In both cases, respite care and general inpatient hospice care is a short-term hospice care solution to manage uncontrolled pain or symptoms. In contrast, routine hospice care at home is provided over days, weeks or months as needed.
2. Respite and general inpatient hospice care reimbursement is limited to specific rules
Medicare will cover the cost of inpatient respite care and general inpatient hospice care if the patient meets criteria as an appropriate level of care. 3 However, it does not cover inpatient care outside of these criteria. 4
3. General Inpatient hospice care is meant to be an extra level of support
Inpatient care can be a helpful short-term addition to in-home hospice care for pain and symptoms that are unable to be managed at home under routine care.
During the time a person receives care at an inpatient location, hospice will continue providing care coordination with the facility so the person can receive services that help them return home for ongoing hospice care when pain or other symptoms are more managed.
Managing Symptoms and Pain Through General Inpatient Hospice
Some of the services provided by general inpatient hospice include:
- Intravenous medications for pain and nausea
- 24/7 nursing care
- Personal care (bathing, dressing)
- Social services
- Emotional and spiritual support
- Volunteer help
For families who may feel anxious about receiving care at home, it’s important to remember that your home environment is optimized for your comfort. At home, you can make the most of hospice with ongoing care in the place most familiar to you, with family and friends close by. In your home, it is also easier to follow your familiar routines and maintain a sense of privacy and quiet. Your hospice team will work to ensure that you are receiving the appropriate level of hospice care and the right support to help improve your quality of life.
Your Hospice Team Can Explain Which Type of Care is Best for You
Each person’s situation is different and will affect what level of care a patient may need, and these levels will likely change as the patient’s condition changes. Your hospice team will work with you and your loved ones to facilitate the best location for your care and help you understand the process.
If you’re still not sure if hospice care is right for you, you can take our hospice quiz, or contact an Amedisys care center near you. We’re here 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.
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