It’s a common question asked by family members. “Does hospice mean 24-hour care?” The answer is complex, because there are many variables to consider.

Medicare has guidelines that define different levels of care. Understanding these levels is essential as family members make care choices for someone they love who is terminally ill.


Who Needs Hospice Care?

One of the first things to consider is whether or not hospice care is appropriate. Hospice is a specific service—one that does not fit every scenario. It is defined as end-of-life care. In other words, hospice is for those with a terminal illness. Through hospice care, medical professionals and volunteers provide:

  • Pain and symptom management
  • Emotional and spiritual support
  • Family education and support

The purpose of hospice care is to improve a person’s quality of life as they reach their final days. That means different things to different people, however, so the staff does an assessment to create an individualized care plan.

Hospice care is available:

  • At home
  • In a hospice facility
  • In a hospital
  • In a nursing home

Each location designates a different type of care. The decision to call in hospice is not an easy one, especially if you don’t understand the different levels of care.


What Are Medicare’s Levels of Care?

Under Medicare, there are four defined levels of care:

  • Routine Home Care
  • Continuous Home Care
  • General Inpatient Care
  • Respite Care

Each one provides a necessary service.

Routine Home Care, or Level One

Routine home care is the most basic level. It is appropriate for patients in need of standard support services, such as:

  • Nursing care
  • Physician management
  • Social services
  • Home health aide services
  • Emotional, spiritual, and nutritional counseling
  • Medication
  • Medical equipment
  • Medical supplies
  • Therapeutic care, such as physical therapy

Continuous Home Care, or Level Two

Level two hospice care is designed for home care that goes from eight to 24 hours a day. Ongoing care is a day-by-day prospect. It might be necessary for a terminal patient who is having uncontrolled symptoms. Specific symptoms can require a nurse or home health aid to stay with the patient, such as:

  • Pain not responding to medication
  • Nausea or vomiting
  • Shortness of breath
  • Problems with the patient’s primary caregiver, such as illness or injury

Continuous care is not the same thing as respite care, which gives caregivers a chance to take a break to avoid burnout. Constant care has a targeted goal and ends when that goal is met.

General Inpatient Care, or Level Three

As the name suggests, general inpatient care provides support when a person moves to an inpatient facility, such as a hospice center, hospital, or nursing home. In many cases, they move because their symptoms are too severe to manage in a home care situation.

Some hospice services have their own inpatient facilities that are separate from a hospital or nursing center. There are also inpatient hospice units in some hospitals or nursing homes.

Respite Care, or Level Four

Respite care is about providing support to home caregivers.

It is hard to care for a family member at home. It takes time and energy, and it is emotionally draining. Respite care gives these caregivers a chance to step away, whether it is for their mental health or because they need to attend to a personal matter.

Respite care can last anywhere from a few hours to five days, depending on the need. Long-term respite care that extends more than just an hour or two is done in a hospice center or medical facility. When the respite period expires, the patient is released back into the family’s care.


How to Decide Which Level of Care Is Right

This is a decision that the hospice service can help families make. If a patient is in a hospital, the assigned social worker will likely make a recommendation. Families can sit with hospice staff and talk about their needs to get advice as well.

The goal of the level of care system is to ensure that each patient and family gets the proper support at the right time. If that means 24-hour service, then that is available if warranted. For more information about levels of service in hospice, give us a call.