The Four Levels of Hospice Care

For patients that are eligible for hospice, the Medicare Hospice benefit covers the identified four levels of care.  The payments from Medicare include all services, medications, equipment and supplies related to the terminal illness for each level of care. 

Precious is able to transition patients who are eligible to hospice care so they are able to take advantage of all of the covered services and supplies that are available to them.

The four levels of care are categorized as the following:

Routine Home Care

The majority of hospice services are provided via routine home care.  In 2015, 98.7% of hospice care provided was in this category.  Routine home care includes scheduled, routine visits in the home by a multidisciplinary care team, including hospice physician, registered nurse, hospice aide, social worker, chaplain, volunteer and bereavement specialist. “Home” is defined as the patient’s residence, which may be a private home, assisted living facility or nursing facility.

Continuous Home Care

Continuous home care is available during times of crisis when a higher level of continuous care is needed for at least eight hours in a 24-hour period to achieve palliation or management of acute medical symptoms.  Fifty percent of the care needed must be provided by a nurse.

Inpatient Care

Some patients have short-term symptoms so severe they cannot get adequate treatment at home, or they may feel more comfortable getting treatment at an inpatient facility.  Symptoms requiring inpatient care are the same as those requiring continuous care, only the setting of care may be different.  With inpatient care, nurses are available around the clock to administer medications, treatments, and emotional support to make the patient more comfortable.

Respite Care

Primary caregivers are at risk for burnout—respite care can provide a temporary break.  Respite care services are more for the family than for the patient.  If the patient does not meet the criteria to qualify them for continuous care or inpatient care, but the family is having a difficult time, respite care may be an option.  If a patient’s family is the primary source of care and cannot meet their loved one’s needs due to caregiver stress or other extenuating circumstances, a patient may temporarily be admitted to an inpatient environment to give the family a needed break.There is a five-day limit on respite care. Once that period expires, the patient is discharged and returns home.

References

Department of Health and Human Services, Centers for Medicare and Medicaid Services. (2004). CMS manual system. Retrieved from https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r15bp.pdf.