Hospice patients may require differing intensities of care during the course of their disease. The Medicare Hospice Benefit affords patients four levels of care to meet their clinical needs: Routine Home Care, General Inpatient Care, Continuous Home Care, and Inpatient Respite Care. Payment for each covers all aspects of the patient’s care related to the terminal illness, including all services delivered by the Interdisciplinary team, medication, medical equipment and supplies. Nearly ninety-seven percent of hospice care is provided at the routine home care level.
Routine Hospice Care is the most common level of hospice care. With this type of care, an individual has elected to receive hospice care at their residence, which can include a private residence, assisted living facility or nursing facility.
General Inpatient Care is provided for pain control or other acute symptom management that cannot feasibly be provided in any other setting. General Inpatient Care begins when other efforts to manage symptoms have been ineffective. General Inpatient Care can be provided in a Medicare certified hospital, hospice inpatient facility, or nursing facility that has a registered nursing available 24 hours a day to provide direct patient care.
Continuous Home Care is care provided for between 8 and 24 hours a day to manage pain and other acute medical symptoms. Continuous home care services must be predominately nursing care, supplemented with – caregiver and hospice aide services and are intended to maintain the terminally ill patient at home during a pain or symptom crisis.
Inpatient Respite Care is available to provide temporary relief to the patient’s primary caregiver. Respite care can be provided in a hospital, hospice facility, or a long term care facility that has sufficient 24 hour nursing personnel present on all shifts to guarantee that patient’s needs are met. Respite care is provided for a maximum of 5 consecutive days.
While hospice patients may be admitted at any level of care, the progression of their illness may require a change in their level of care. Although the Medicare Hospice Benefit is designed to offer patients care where they live (including nursing homes), a hospice will help transfer a patient to inpatient care if necessary for pain and symptom management.
In 2012, the four levels of care were provided in the following amounts*:
- Routine Home Care 96.5%
- General Inpatient Care 2.7%
- Continuous Care 0.5%
- Respite Care 0.3%
* This information available in the NHPCO publication “Facts and Figures: Hospice Care in America” (2013 edition).