Many terminally ill patients wish to spend their final months or weeks at home surrounded by loved ones instead of in the hospital. Hospice care extends beyond medical services and helps make the patients’ wishes for end-of-life possible with resources and a support team available at many different stages.
Whether in the home or in a residential facility, such as an assisted living center or nursing home, a dedicated hospice care team can provide various levels of support by giving their full attention to someone in their final weeks or days.
When the Tax Equity and Fiscal Responsibility Act (TEFRA) established the Medicare hospice benefit in 1982, it was to include support for family members and caregivers along with the patient, and outlined four “levels of care” that Medicare-certified hospice providers must offer:
- Routine home care (also called Routine In-Home Hospice)
- Continuous home care
- General inpatient care
- Respite care
4 Levels of Hospice Care
Heart to Heart Hospice provides various levels of care designed to meet the patient’s needs in alignment with the Medicare hospice benefit. The hospice care team and the patient’s physician will determine the best level of care. While physical comfort and pain management are one aspect, hospice services provide mental, emotional, spiritual, and practical support.
Routine Home Hospice Care
The most-used level of care is routine home care, with regularly scheduled visits by the hospice care team to meet the medical, emotional, spiritual, and practical needs of patients and their loved ones. This is provided nearly anywhere a patient calls home, be it a private residence, a nursing home, or residential facility.
Continuous Home Hospice Care
Continuous care is provided only during a period of crisis, as necessary to maintain a patient at home.
A crisis period is when a patient’s physical symptoms cannot be managed effectively with intermittent visits. Hospice nurses and aides provide round-the-clock care, predominantly nursing care, to control pain or manage acute medical symptoms. Once symptoms are managed effectively, the patient can return to routine intermittent care team visits.
Inpatient Hospice Care
When a hospice physician determines that a patient needs short-term management of pain or symptoms that cannot be controlled at home, inpatient hospice care is employed.
The patient is transferred to a contracted nursing facility, hospital, or inpatient hospice unit. When the symptoms are controlled, the patient may return home.
Respite Care
When family caregivers need time away from their caregiving responsibilities or if an urgent situation arises, respite care (short-term, in-home care) is available to hospice patients.
Patients may receive care in a contracted facility or hospice inpatient unit for up to five days.For families that need long-term placement versus a temporary respite stay, they may choose to pay out of pocket for room and board in an inpatient facility and receive routine home care.
Care Team Support
At all levels of hospice care, you’ll find a team ready to support you or your loved one in ways of which may not have been previously aware. Examples of the different types of hospice support provided include (but are not limited to):
- Hospice Physician — Specially trained hospice medical directors oversee the care of hospice patients. They guide and direct the care team to ensure each patient’s needs are met and symptoms are optimally managed.
- Nurses — Provide care and pain management, note changes in a patient’s condition, educate the family on medical and physical needs, coordinate doctors, health care providers, and medical equipment and supplies.
- Social Workers — Identify psychosocial, grief, financial, environmental, and community needs. Offer counseling and support. Facilitate community resources. Provide information and assist with preparation of advance directives.
- Spiritual Care Coordinators — Listen and assist with spiritual needs. Collaborate with local clergy as needed. Offer counseling and support, prayer, worship, ritual as appropriate. Provide individual patient/family counseling and/or crisis intervention.
- Home Health Aides — Help with activities of daily living (bathing, grooming, etc.), light homemaker services, assist patients with safe transfers, nutrition, and environment.
- Bereavement Coordinators — Coordination of a bereavement care plan and support for family up to 13 months after loss.
- Volunteers — Provide companionship to patients and families. If you are interested in becoming a hospice volunteer, learn more here.
Routine hospice visits, along with our 24/7 support line to triage new symptoms or changes, help determine what level of care is necessary and available. The levels of hospice care and the dedicated team mean caregivers and patients always have somewhere to turn for support, comfort, and guidance.
To learn more about the different levels of hospice care for yourself or a family member, contact a Heart to Heart location near you or refer a loved one to our services.
Read these Questions to Ask When Choosing a Hospice Provider.
