Understand the 4 Types of Care Offered by Hospice

Understand the 4 Types of Care Offered by Hospice

There are four levels of care provided by hospices in the United States. Every patient receiving hospice services will be on one of these four levels. A hospice patient can move from one level to another and back, depending on the services required to fulfill his or her needs. The need of the patient will determine their individual level of care.

Routine Home Care

Patient at home with symptoms controlled

A patient will be placed at this level of care if he or she resides at home (or a long-term care facility) and does not have symptoms which are out of control. These symptoms could include—but aren’t limited to—severe pain, continuous nausea and vomiting, bleeding, acute respiratory distress, and unbearable restlessness or agitation. A patient at this level has access to the following services:

  • Registered Nurse Visits
  • Social Worker Visits
  • Chaplain Visits
  • Home Health Aide Services
  • Counselors
  • Medications
  • Equipment

The needs of the patient determine the number of visits from hospice staff members. These needs are established and outlined in a plan of care formed by the hospice team and the patient’s physician. The care plan serves as a guideline to assist all those serving the patient with care. At this level of care the patient also has access to an on-call hospice nurse twenty-four hours a day.

Inpatient Care

Patient in facility with uncontrolled symptoms

A hospice patient may require inpatient care when his or her symptoms have gotten out of hand and can no longer be managed at home. When these symptoms cannot be controlled on routine home care, then the patient requires extra attention until these symptoms subside. Hospices take aggressive actions to control the symptoms and make the patient comfortable. In order to do this, the patient may be temporarily placed in a hospice home or an acute care hospital. At this level of care, a moment-to-moment assessment of what’s happening and what needs to be done takes place. The hospice team and the patient’s physician work together to ensure the patient obtains and maintains a tolerable comfort level. Once this has been achieved, the patient will return home and back to routine home care.

Respite Care

Patient at facility with symptoms controlled

A patient may be moved to respite care when the caregiver needs a break. Many hospice patients live at home, with their family providing most of the care, sometimes around the clock. Caring for their loved one can be exhausting and very stressful. The family members and/or caregivers need time to themselves and it’s important that they take that time. Respite care allows a patient to be temporarily placed in a facility with 24-hour care so the family can rest. If the patient is willing and the family requests it, hospice must provide placement in a facility or a hospice home for the patient. The patient will be transferred to the facility, and according to Medicare regulations, can stay for up to five days before being transferred back home.

Continuous Nursing Care

Patient at home with uncontrolled symptoms

A patient would receive continuous nursing care if he or she has symptoms that are out of control and choose to stay at home. This is similar to inpatient care, except that the patient remains in his or her home instead of being placed in a facility. A hospice nurse is required to provide continuous around-the-clock nursing care if the symptoms cannot be controlled while on routine home care. According to the Hospice Patients Alliance, there is only one exception to this requirement: if the hospice has fewer than seven employees, is in a rural or nonmetropolitan area, and does not have the staff to provide continuous nursing care in the home. However, most hospices are required to provide this level of care if it is needed.


5 months ago, said...

My 96 yr old mother lives with me in my home, She transitioned to Hospice Care in March of this year. I was never informed of her treatment plan, nor her determined level of care. Someone must be present at all times to insure my mother's safety, and provide for her physical needs. I provide her care 24 hrs per day, 7 days per week. A hospice nurse generally visits once each week, but not always; and a home health aide comes for one hr per day, three times a week to give my mother a bed bath. My mother's primary care physician prior to her admittance to Hospice has continued as her physician through Hospice. This physician submitted a new script for 4 hrs per day, three days per week of home health aide services when she became aware that I was on duty 24/7. My concern, and my mother's physician's concern is the quality of care which I am able to provide, given my symptoms of sleep deprivation. I am attempting to provide my mother with the highest quality of care while operating on 2-3 hours sleep per 24 hours. Mother's Hospice organization has chosen to ignore the Dr's orders, stating that there is no provision for anything other than one hour per day available to my mother for home health aide services. I am afraid to make an issue of this because I am concerned that if I am labeled a "trouble maker" that it will impact the limited services that are now provided to my mother. This concern is predicated upon the negative response I received from Mother's Hospice team when I inquired about the implementation of Mother's physician's new orders. (My mother is a Medicare recipient.) Has anyone else confronted this problem? Thank you.


about 1 year ago, said...

my sister is in hospice---but she is not eating. She is considered level one but is presently in a group home environment. I hate seeing her growing so very thin. Is there anything to do at this point?


over 4 years ago, said...

My mom was admitted to Hospice. They say she is a Level one, what does that mean?


almost 6 years ago, said...

Hi Paki, thanks for your comment. To answer your question, the 4 levels of care are: Routine Home Care, Inpatient Care, Respite Care, and Continuous Nursing Care. They aren't traditional "levels," it's just a gradient of care from less needs to more needs. I hope that helps. Thanks -- Emily | Community Manager


almost 6 years ago, said...

What are the 4 levels. Article is incomplete.