Hospice care is for patients who are diagnosed with a terminal illness and the prognosis suggests they have six months or less to live. Hospice care providers that are Medicare-certified must offer four levels of hospice care, which are defined by The Centers for Medicare & Medicaid Services.
As the patient’s condition worsens, they may progress into other levels of hospice care. For example, a terminally ill patient may begin hospice care with routine home care and transition into continuous home care and general inpatient care as symptoms become more severe.
Routine Home Care
Routine home care for hospice patients is covered by Medicare part A and B. It is for patients who have tolerable symptoms that do not require around-the-clock management. The services a patient may receive under routine home care include nursing, occupational therapy, physical therapy, pathology services, medical equipment and medical supplies for use at home.
Routine home care allows hospice patients to receive the support and medical care they need without leaving their home. This allows them to keep their daily routine as similar as possible while receiving hospice care.
Continuous Home Care
Continuous home care is at-home hospice care that offers 24/7 support. Although it most often takes place at home, continuous care can also be provided in assisted living facilities or nursing homes. It is designed for terminally ill patients who experience moderate to severe acute symptoms. These symptoms may include but are not limited to:
- Severe acute pain
- Nausea and vomiting
- Severe anxiety
- High risk of seizures
- Difficulty breathing
Although each provider may have a different process, continuous home care typically involves hospice workers taking shifts to ensure the patient and their family have the around-the-clock support they need while acute symptoms exist. The hospice care physician may also stay in constant communication with the patient’s primary care physician.
General Inpatient Care
Symptoms that often lead to a need for treatment in an inpatient facility are similar to the acute symptoms that require continuous home care, although they may be worse and require the need for more complex medical equipment and extensive monitoring by the hospice team. Some patients may enter into inpatient care out of necessity due to their symptoms, but others may choose general inpatient care to ensure the fastest and most reliable treatment possible.
Respite care is offered when the primary caregiver is mentally or physically exhausted and needs a break or will not be available temporarily (e.g., while taking a trip). With respite care, the patient checks into the inpatient facility and their physical and emotional needs are met by the hospice staff. Respite care is limited to five days at a time.
A caregiver may need respite care if they need to take several days of rest to ensure they are in a mental and physical state to properly care for the patient. They may also require respite care if they have a wedding, graduation or another event they plan to attend. This ensures that the patient gets the care they need while also giving the caregiver the support and rest they desire as well.
How to Determine Level Needed
To be eligible for hospice care, the patient’s doctor and the hospice care facility must determine the patient has a life expectancy of six months or less. This includes most who are in the more progressive stages of a terminal illness.
In deciding which of the four levels of hospice care are most appropriate, the hospice facility will examine the severity of the patient’s symptoms, the quality and amount of care they are able to receive at home and consider the preference of the patient and their family.
In general, patients who deal with tolerable symptoms most days are eligible for at-home hospice care, whereas those who have more severe symptoms may require general inpatient care. Of course, the level of hospice care may change periodically, such as if the caregiver needs a break from routine home care and elects to use respite care for several days.
Contact The Hospice Care Experts
The best way to determine which level of hospice care is most appropriate is to discuss all options with a hospice care facility. You can reach out to our hospice care experts today for more information about the different levels of hospice care.
We can answer any questions you may have about hospice care for yourself or for a loved one. We understand how stressful end of life care can be, and we are here to help patients live a good quality of life and get the physical, emotional and spiritual support they need.