Admissions Resource Center

Four Levels of Hospice Care

In addition to unique qualities and variations between one hospice provider and another, the hospice benefit has many standardized, or universal, features identified in the Conditions of Participation defined by Medicare. The Conditions of Participation identify guidelines by which all hospices are governed. The four levels of care for hospice, and the qualifying criteria for each, are among these many guides and impact delivery of hospice services, and are tied to appropriate Medicare billing by all hospice agencies. A brief explanation of each level of care is provided below:

Routine Care - Indicates the patient’s comfort is being maintained, their symptoms are well controlled - this is the number one priority for hospice. The nurse likely visits the patient weekly, the social worker and chaplain visit a few times per month and the home health aide visits a few times per week. This is a time where rapport and trust are developed between a patient and their clinical team through ongoing education about end-of-life processes, and related resources are provided to help the patient, family and friends with final tasks.

Continuous/Crisis Care - Occurs in the patient's place of residence if symptoms of discomfort develop which cannot be adequately controlled with the medications and tools already on hand. A hospice nurse remains with the patient for prolonged periods of time, to carefully observe changes in the patient and frequently adjust medications as necessary in consultation with the doctor, until the patient returns to the desired level of comfort - as defined by the patient. Other team members are likely to also increase their number of visits to provide added support as needed. The goal is to return the patient to a level of optimum comfort, and hospice team member visits to return to routine level of care frequencies.

General In-Patient (GIP) Care provided at Pacifica House - Occurs for the same reasons as Continuous/Crisis Care - patient's symptoms are not well managed and need better palliation (improved comfort of the patient). The patient may return to their place of residence once their comfort has been attained.

Respite Care at Pacifica House - Respite Care is the only level of care that is not dependent upon the patient's symptoms. Respite care involves relocating the patient for five days to Pacifica House if a bed is available or skilled nursing facility to permit a period of rest or recreation for the patient's primary caregiver. The hospice team will resume their visits to the patient's residence upon the patient's return home. With input from patient and family, hospice coordinates all aspects of the five-day respite.

The "Four Levels of Hospice Care" and a patient's transition from one level of care to another are based on individual patient needs, and all factors to justify a change from one level of care to another are carefully and thoroughly documented by the hospice team to remain in compliance with the Medicare Conditions of Participation.