When someone is nearing the end of their life, hospice care is an option that can provide them comfort and care during their final days. Family members can then begin to look at different types of hospice care that is available for their loved one. As categorized by the Centers for Medicare and Medicaid Services (CMS), there are four levels of hospice care that are covered by Medicare, and patients will move between the levels of care depending upon what level of services are required during a particular time frame. Here, we will explain each type of care and what they entail.
Routine Home Care
According to the CMS, this is the type of care that is usually most suitable for a hospice patient who isn’t in crisis. Routine home care doesn’t necessarily take place at a patient’s house. It can also be hospice care at a skilled nursing facility or an assisted living facility, wherever “home” is for the patient. 1 Depending on the patient’s needs, the routine care may consist of various services and day-to-day tasks. For example, patients may receive spiritual counseling for either themselves and/or their family members. Pain and symptom management may also be part of this type of care.
Continuous Home Care
When hospice care is more immediate and intensive, continuous home care may come into play. This type of care, which is usually offered when there is a period of crisis, to achieve palliation and management of acute medical symptoms and consists of the following elements: 2
- The patient receives hospice care in a home setting that isn’t an inpatient facility.
- The care consists of predominantly nursing care but may also include homemaker or/and hospice aide services and is provided for at least 8 hours of a 24-hour period.
With this kind of support, nursing care is provided at home, at an assisted living facility, a long-term care facility (LTC) or non-skilled nursing facility (NF) (if the patient is not receiving a skilled level of care, i.e., Medicare Part A skilled benefit) by a nurse who is employed by the hospice. 3
General Inpatient Care
If a patient’s short-term symptoms cannot be managed at home, then general inpatient care may be appropriate for their needs. Symptom management may include the monitoring of pain, nausea, respiratory problems, seizures or uncontrollable bleeding.4 Symptom management is provided at a hospice inpatient unit, or through contracting with a hospital or skilled nursing facility that also has around-the-clock nursing care services with a registered nurse who is available at all times.
While hospice care is an act of great compassion and support, from time to time caregivers may experience burnout and need to take a little breather from their daily caregiving activities. That’s when respite care comes in. This particular care allows loved ones and caregivers to take a break when they may be feeling emotionally or physically exhausted. However, during this time, the patient may receive inpatient hospice care at an approved facility for a brief period. Typically, respite care allows for up to five consecutive days for the caregiver to get some rest, as noted by the CMS.5
Hospice care is a rather personal decision that can be made with the aid of the patient’s hospice team and loved ones. Having a better understanding of the patient’s hospice care coverage can help make sure the patient receives the care they need.
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1, 2, 4 & 5 Centers for Medicare and Medicaid Services, “Hospice Coverage,” August 17, 2021.
3 National Hospice and Palliative Care Organization, “Continuous Home Care in the Medicare Hospice Benefit,” March 2021.