When a loved one enters hospice, understanding the levels of care available can help families make informed decisions about the different types of support needed. Hospice offers four different levels of care, each tailored to meet the specific needs based on the patient’s condition, comfort, and symptom management requirements at the time.
Let’s examine each level of hospice care and how they best support the patient and the family so you can better understand the options.
Level One Hospice Care: Routine Home Care Offered by a Hospice
Routine Home Care is the most common level of hospice care and is provided to patients in their place of residence, whether it’s a private home, nursing home, or assisted living facility. This level of care is designed for patients whose symptoms are managed well with regular visits from the hospice team.
What is usually Included in Hospice Home Care:
Nursing Visits: Nurses visit regularly to monitor the patient’s condition, administer medications, and provide wound care or other necessary medical assistance.
Home Health Aides: Home health aides assist with personal care tasks, such as bathing, grooming, and dressing.
Social Worker Support: Social workers provide counseling and help with emotional, practical, and financial needs.
Spiritual Counseling: Chaplains or spiritual counselors offer guidance based on the patient’s and family’s spiritual beliefs.
Additional Services: Trained volunteers may offer companionship and support, and therapists may assist with physical or occupational needs if appropriate.
Which Patients Benefit from Hospice Home Care?
Routine Home Care is for patients with manageable symptoms and prefer to remain at home. This level emphasizes comfort and quality of life, with regular check-ins from the hospice team.
Level Two: Full-time Continuous Hospice Care at Home
Continuous Home Care is a higher level of care provided during short periods of crisis when symptoms cannot be managed under Routine Home Care alone. This level includes continuous nursing support for 8 to 24 hours per day to help stabilize a patient’s condition, alleviate any acute symptoms, and oversee the administration of pain medications.
What is Included in Continuous Home Care from Hospice Nurses & Support Staff?
Continuous Nursing Support: A registered nurse (RN) or licensed practical nurse (LPN) provides round-the-clock care to monitor and manage severe symptoms. This care is intended to be temporary and last until the crisis is resolved.
Symptom & Pain Management: The focus is on controlling symptoms such as severe pain, respiratory distress, agitation, or other acute issues that require immediate intervention and alleviation.
Personal Care: Home health aides assist with basic needs during this time, providing comfort and support for both the patient and family.
Which Patients Require this level of Continuous Care?
Continuous Home Care is for patients who experience sudden, severe symptoms or a crisis that requires constant monitoring and treatment. This care is often provided in the home to manage symptoms effectively so the patient can return to Routine Home Care when stabilized.
Level Three: General Hospice Inpatient Care
General Inpatient Care is a short-term level of care provided in a hospital, hospice facility, or skilled nursing facility. It is intended for patients whose symptoms are too complex to be managed at home and require intensive medical supervision to address severe pain, nausea, breathing difficulties, or other challenging symptoms. Specialized equipment may be needed to support a patient with specific symptoms or physical challenges.
What does Inpatient Palliative Care Include?
24-Hour Skilled Nursing Care: Nurses and medical professionals provide constant monitoring and care to address complex or uncontrolled symptoms.
Specialized Treatments: Pain management, intravenous medications, and other treatments may be administered to control symptoms effectively.
Family Support: Hospice staff provide emotional support and updates for families, ensuring that they are informed and comforted throughout the process. This may be a time when hospice support staff work with family members to prepare them for the time of passing, offering spiritual guidance and also practical help to ease the process of making death care arrangements.
Which Hospice Patients Need Level Three Inpatient Care?
General Inpatient Care is for patients with severe symptoms that cannot be managed at home, such as unrelenting pain, severe nausea, or uncontrolled agitation. Once symptoms are stabilized and if the patient’s condition improves, the patient may return to Routine Home Care or Continuous Care.
As much as possible, hospice staff work with patients and families to ensure they can remain in a home environment as long as possible if this is their wish.
It can help to ensure a patient has an Advance Directive to outline the type of palliative end-of-life care they want. This can be prepared in consultation with medical professionals, hospice support staff, counselors, and family.
Read more about the Importance of an Advance Directive here.
Level Four: Short-term Hospice Respite Care to Assist Care-Givers
Respite Care is a unique level of hospice care designed to support family caregivers by providing a temporary break from caregiving duties. During respite care, the patient is transferred to a hospice facility or skilled nursing facility for up to five days, allowing caregivers to rest and recharge.
What does Hospice or Nursing Respite Care Offer?
Inpatient Facility Stay: The patient is admitted to a hospice facility or nursing home for a short-term stay, where they receive the same level of comfort and symptom management as they do at home.
Skilled Nursing Care: Nurses and hospice staff provide comprehensive care to meet the patient’s physical, emotional, and medical needs during their stay.
Safe and Supportive Environment: Patients receive compassionate care in a secure environment, giving families peace of mind while they take a break.
When does a Family opt for Respite Care?
Respite Care is for families and caregivers who need temporary relief to prevent burnout or attend to personal matters. This option is available periodically and provides much-needed support for caregivers who play a critical role in their loved one’s care.
How to Determine the Right Level of Hospice Care for Your Loved One
Choosing the right level of hospice care depends on the patient’s symptoms, their living situation, and the needs of their family or caregivers. Here are some considerations:
Assess Symptom Severity: Routine Home Care may be sufficient if symptoms are under control, but Continuous Home Care or General Inpatient Care may be needed during times of crisis.
Consider a Caregiver’s Needs: Respite Care offers valuable relief and prevents caregiver burnout for families providing care at home.
Consulting with the Hospice Team: Hospice professionals assess the patient’s condition regularly and can recommend the appropriate level of care. They will also assist with transitioning between levels as needed.
What about the Costs and Insurance Coverage for Hospice Care?
Hospice care is covered by Medicare, Medicaid, and most private insurance plans in the U.S., including all four levels of care. This means families can typically access each level without worrying about additional costs.
Coverage includes nursing care, social work, medications, medical equipment, and bereavement support. If you have questions about coverage, contact the hospice provider or your insurance company to ensure your loved one receives the care they need.
In summary, Hospice offers four distinct levels of care—Routine Home Care, Continuous Home Care, General Inpatient Care, and Respite Care—to address the evolving needs of patients and their families during end-of-life care. By understanding each level, families can make informed decisions and ensure their loved one receives the most compassionate and appropriate care available. The hospice team will work closely with you to assess needs and provide the best possible support at every stage of the journey.
For families who need to prepare for a passing and want to arrange a simple and affordable cremation service, DFS Memorials is here to guide them. All providers in our network offer the best-value direct cremation option to their local community.
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I have been researching and writing about the death care industry for the past fifteen years. End-of-life services and experiences are topics most people avoid thinking about until they must face them. My work provides comprehensive and independent resources for families, explaining the workings of the funeral industry, the laws governing funeral practices, and the death care trends that impact consumers. With a BA in Cultural Studies, I bring a unique perspective to analyzing cultural death care rituals, complemented by a career background in Business Management. The death care industry is undergoing significant changes, which I find fascinating. The shift towards cremation services and the emergence of sustainable alternatives like aquamation and human composting are of particular interest. I am also intrigued by how technology is reshaping the funeral planning process and experience. I write for US Funerals Online and DFS Memorials LLC, and contribute to various forums and publications within the death care industry.
