End of Life Concerns Hospice Care Levels of Hospice Care as Defined by Medicare By Angela Morrow, RN linkedin Angela Morrow, RN, BSN, CHPN, is a certified hospice and palliative care nurse. Learn about our editorial process Angela Morrow, RN Fact checked by Fact checked by Elaine Hinzey, RD on February 17, 2020 linkedin Elaine Hinzey is a fact checker, writer, researcher, and registered dietitian. Learn about our editorial process Elaine Hinzey, RD on February 17, 2020 Print 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. 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. Medicare defines four distinct levels of hospice care. This benefit provides goods and services to allow you and your family to stay together in the comfort of your home, unless you need care in an inpatient facility, for the duration of your terminal illness. Under the Medicare hospice benefit, the patient is still responsible for the deductible and coinsurance amounts for expenses incurred due to health problems not related to the terminal illness. 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. Every Medicare-certified hospice provider must provide these four levels of care. Level 1: 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. Routine home care services include: Part-time or intermittent skilled nursing servicesPhysical therapyOccupational therapySpeech-language pathology servicesMedical social servicesPart-time or intermittent home health aide servicesMedical supplies for use at homeDurable medical equipment (Medicare will cover 80% of the cost)Injectable osteoporosis drugs Level 2: 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. Symptoms Requiring 24/7 Care Some examples of symptoms requiring continuous care would be:Unrelieved painSevere nausea and vomitingSevere shortness of breathAnxiety or panic attacksA breakdown in the primary caregiver support system Level 3: General Inpatient Care Some patients have short-term symptoms so severe they cannot get adequate treatment at home, or they may feel more comfortable getting treatment at an inpatient facility. Andersen Ross/DigitalVision/Getty Images 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. Inpatient Facilities There are several types of facilities that offer inpatient hospice services:A free-standing facility owned and operated by a hospice companyAn inpatient hospice unit within a hospitalA hospice unit in a skilled nursing facility (nursing home) Level 4: 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. There is a five-day limit on respite care. Once that period expires, the patient is discharged and returns home. Determining Level of Care In order to qualify for hospice care, the patient's doctor, and often a hospice doctor as well, must determine that the patient is terminally ill, with a life expectancy of six months or less; the decision to treat someone at a higher level of care falls to the hospice physician. With four levels in place, no terminally ill patient should ever be left without the appropriate care. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Harris PS, Stalam T, Ache KA, et al. Can hospices predict which patients will die within six months?. J Palliat Med. 2014;17(8):894-8. doi:10.1089/jpm.2013.0631 Samaritan Healthcare & Hospice. What are the four levels of hospice care? Medicare.gov. Home health services coverage. CGS. Continuous home care. Medicare Benefit Policy Manual. Centers for Medicare and Medicaid Services. How hospice works. Medicare.