Levels of Hospice Care by Definition
When a doctor determines that a patient most likely has no more than six months to live, the person or their family may choose to stop trying to cure the illness, and opt to receive hospice care instead.1 Hospice, also called "comfort care," focuses on managing pain and keeping a person comfortable so that they can enjoy a good quality of life for the remainder of their time left.
One person may experience all four levels, perhaps in just a week or 10 days of hospice services. Another person may experience one level of care throughout the duration of his or her hospice care. Each level of care meets specific needs, and every hospice patient is unique.
Level I: Routine Home Care
Routine home care is the basic level of care under the hospice benefit. It is covered for homebound individuals with Medicare part A and B who are under the care of a doctor who has specified the services are needed. The amount, frequency, and time period of the treatment must be reasonable and you must be expected to improve in a reasonable and predictable amount of time.3 Routine home care services include:
- ♦ Part-time or intermittent skilled nursing services
- ♦ Physical therapy
- ♦ Occupational therapy
- ♦ Speech-language pathology services
- ♦ Medical social services
- ♦ Part-time or intermittent home health aide services
- ♦ Medical supplies for use at home
- ♦ Durable medical equipment
- ♦ Injectable osteoporosis drugs
Level II : 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.
Level III: General Inpatient 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.
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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
Level IV: Respite Care
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 or respite