The four levels of hospice care

Routine home care

This is the usual level when the person is not experiencing a crisis requiring more intensive care. “Home” can be a private residence or a place such as assisted living or a nursing facility. The care plan includes visits and support based on individual needs. The word routine describes the level of care; it does not mean the person’s symptoms or family concerns are unimportant.

• Ask the team: Who will visit, what help is available between visits, and which changes should we report immediately? If the person lives in a facility, which tasks belong to facility staff and which belong to hospice?

Continuous home care

During a brief medical crisis, more intensive care may be provided at home to manage acute symptoms and help the person remain there. Medicare requires at least eight hours of eligible care in a 24-hour day, with care predominantly provided by nursing staff. Hospice aides may supplement nursing. This level is not ongoing round-the-clock personal care or an automatic solution for a caregiver who needs long-term help.

• Ask the team: What symptom requires crisis care, how will it be reassessed, and what is our plan when the crisis improves? If this level is not appropriate, what other help can we arrange?

Inpatient respite care

Respite provides a short stay in an approved inpatient setting to give the usual caregiver a rest. Under Medicare, it may be provided for up to five consecutive days at a time. It is intended for temporary relief, rather than permanent placement. The hospice arranges the stay; discuss availability, transportation, medicines, personal items, and the return-home plan before making independent arrangements.

• Ask the team: Where would respite take place, what costs might apply, and how early should we request a stay? Who will contact us if the person’s needs change while they are there?

General inpatient care

This is short-term care for pain or other symptoms that cannot be managed in another setting. It is provided in an appropriate inpatient facility through hospice arrangements. It is not covered simply because a person needs a place to live or a family cannot provide care. As symptoms improve, the team plans a return to a less intensive setting that can meet ongoing needs.

• Ask the team: What needs inpatient treatment, how is improvement assessed, and where could care continue afterward?

Tell the team when the plan is no longer working

Families do not need to identify a billing category. Describe the problem: uncontrolled symptoms, a difficult overnight change, exhaustion, or concern about safety. Ask the hospice to explain the appropriate response and what support is available now. Keep the after-hours number accessible, and ask for a written plan for symptoms and transfers before a stressful moment arrives.