Home Health & Wellness What Are the 4 Levels of Hospice Care? A Comprehensive Guide

What Are the 4 Levels of Hospice Care? A Comprehensive Guide

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Hospice care is a type of healthcare service provided to patients who have a life-limiting illness and are approaching the end of their lives. The focus of hospice care is on symptom management, pain relief, emotional and spiritual support, and improving quality of life for both the patient and their family.

According to Meridian Hospice, this care involves a team approach that includes doctors, nurses, social workers, chaplains, volunteers, and other healthcare professionals. This type of care aims to provide comfort and dignity during a very difficult time.

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In hospice care services, there are four levels of care:

  • Routine home care. This is typically used when patients can stay at home with supportive services while palliative or comfort measures are provided by the hospice team.
  • Continuous home care. Provides around-the-clock nursing support when patients experience an increased severity of symptoms such as pain crises or shortness of breath.
  • General inpatient care. It takes place when symptoms can no longer be managed effectively at home or when carers need respite from caring for an ill loved one at home. It may also be used for symptom control that cannot be achieved in any other setting due to complexity or severity.
  • Respite care. Gives carers a break from taking care of their loved ones by providing temporary relief.

It’s important to choose the right level of hospice care because each has unique features that cater to specific needs. 

Benefits of hospice care

Hospice care brings several advantages to patients facing the end of their lives. These include:

  • Pain and symptom management. Hospice care provides comfort and pain alleviation for patients with terminal illnesses, making them less dependent on medications that could reduce their quality of life during their final moments.
  • Emotional and psychosocial support. Hospice care gives emotional and psychosocial support to patients and families, helping them navigate the psychological challenges of death and bereavement, as well as offering counselling services for those affected by this time in life.
  • Care coordination. Hospice care providers facilitate coordination between different medical professionals, such as oncologists or palliative care physicians, enhancing the chances of successful symptom management in end-of-life care.
  • Assistance with daily tasks. Hospice care offers much-needed help with activities of daily living such as bathing, grooming, dressing, toileting, housekeeping, etc., giving family carers a much-needed respite from these responsibilities.
  • Spiritual support. Hospice also provides spiritual counselling services based on religious faith or personal belief systems to improve individuals’ spiritual wellness during their dying process.
  • Fosters dignity and peace. Finally, hospice encourages an environment focused on patient dignity, reducing distressing symptoms through comprehensive home-based support tailored to each patient.

Additionally, hospice team members can often provide guidance regarding advance directives or legal issues that may arise towards the end of life.

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The 4 levels of hospice care

Routine home care

Routine home care is a prevalent level of hospice care that offers services in the patient’s home. This level of care has been designed for patients who have opted out of hospitalisation or skilled nursing facility care and, instead, wish to stay at home. Under this level of hospice care, trained professionals provide their services, which include evaluations, assessments, symptom management and support for family members. These carers allow patients to receive continued treatment while still being able to maintain independence.

Patients opting for routine home care get a team consisting of doctors, nurses, social workers, chaplains, counsellors, and trained volunteers who offer round-the-clock support through phone calls or visits, depending on medical necessity. Other than regular personalised attention to handle physical discomforts like pain relief, etc., assistance with mobility and personal hygiene is also provided under this category.

It is important to note that routine home care does not cover expenses beyond what has been agreed upon by the individual’s health insurance provider. Finding the right balance between quality healthcare service and affordability can sometimes feel overwhelming but contacting a hospice care provider could be an excellent solution here, as they provide inclusive plans suitable based on individual needs. By engaging healthcare specialists promptly, they can guide you further on the various plans available in your locality related to routine homecare, facilitating beneficial choices.

Eligibility for Routine Home Care

To be eligible for receiving routine home care services in hospice, patients must meet specific requirements. 

Patients with any stage of a life-limiting illness are eligible for this level of care, where they can receive in-home medical care and support from a hospice team. The primary criterion for being deemed eligible for routine home care is the patient’s prognosis, with expected survival rates of six months or less.

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Continuous home care

Continuous home care refers to a level of hospice care provided to terminally ill patients who require round-the-clock care in their own homes. This level of care is meant to offer relief and comfort towards the end-of-life stage. A team of healthcare professionals, including registered nurses, nursing assistants, social workers, and chaplains, provides continuous nursing services and support. Patients who qualify for this level of hospice care are those experiencing severe pain or other distressing symptoms that require frequent medication adjustments by skilled healthcare providers.

Patients and families considering continuous home health services could benefit from setting up an around-the-clock carer schedule by using family members, friends, professional carers, or volunteers from hospice service support programmes. It’s critical to develop an emergency plan if the patient’s condition worsens suddenly during off-hours when traditional medical attention may be unavailable.

Eligibility for Continuous Home Care

It should be noted that eligibility for continuous home care is dependent on various factors, such as symptom control, carer availability, and adequate space for providing palliative care in in-home environments. Finally, patients or their family members must consent to receiving continuous home care services.

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General inpatient care

General inpatient care refers to a hospice care level designed for patients who require extensive medical intervention to manage acute symptoms. It is provided in a hospital or healthcare centre. Patients receiving this level of hospice care generally have symptoms that cannot be managed at home or need closer observation by medical professionals. 

In general inpatient care, the hospice team works hand in hand with the patient’s primary physician for prompt and targeted medical attention.

Typically, patients under general inpatient care receive around-the-clock monitoring from nurses, physicians and other healthcare providers specialising in pain management, palliative care and other services to alleviate patients’ symptoms. Hospice team members provide comfort measures, medication assistance, and intravenous (IV) fluid provision, among other nursing interventions.

Another notable aspect of general inpatient care is access to medical equipment available within the facility, such as oxygen tent ventilators and pain pumps, which are used to improve symptom control among patients.

Eligibility for general inpatient care

Patients who require a higher level of care than routine home hospice care may qualify for eligibility for general inpatient care. This level of care provides around-the-clock medical attention and visits from interdisciplinary teams. There is a strict requirement to meet specific symptom criteria, such as uncontrolled pain or nausea, which may be complicated by acute medical issues such as cancer comorbidities or life-threatening conditions.

To be eligible for general inpatient care, patients must:

  • Have a prognosis of six months or less
  • Have advanced orders indicating the need for this specialised service
  • Show symptom characteristics necessitating 24-hour monitoring and management due to imminent danger
  • Are unable to manage their symptoms with less intensive interventions
  • Have consented to transition from their current place of residence

It’s important to note that eligibility for general inpatient care can be temporary and will be reassessed regularly. 

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Respite care

Respite care is a level of hospice care that provides temporary relief to the carer by giving them a break from caregiving. During respite care, the patient temporarily stays in hospice care, allowing their carers to take some time off and recharge their energy.

In respite care, the patient receives all the necessary medical and supportive services, including medication management, personal hygiene assistance, and symptom management.

A unique aspect of respite care is that it can be provided either at home or in an inpatient setting. The duration of respite care can range from a few hours to several days.

It is important to note that respite care is intended for short-term use only and should not replace routine homecare or other levels of hospice care permanently. There are no limits to how often one may utilise respite care, as long as it is reasonable and necessary.

In some cases, insurance may cover part or all of the costs associated with respite care. It’s always advisable to speak with one’s insurance provider to understand what benefits they offer for this service.

Eligibility for respite care

Patients can be eligible for respite care, which provides temporary relief to the patient’s usual carers or family members. This is typically provided on an intermittent or short-term basis and may occur in a hospice facility, hospital, or nursing home setting. The eligibility for respite care varies by hospice provider but usually requires the patient to have had a certain number of days of hospice service prior to requesting respite care.

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Final thoughts

In conclusion, understanding the four levels of hospice care is essential. These levels include routine home care, continuous home care for acute symptoms, general inpatient care, and respite care. Each level offers specific services tailored to the needs of patients and their families, ensuring comfort and support during the end-of-life journey.

What is hospice care? What you need to know about hospice

Dr Olivia Montgomery is an esteemed expert in hospice care and palliative medicine. With a strong commitment to compassionate support, Dr Montgomery has made significant contributions to the field. Currently affiliated with Partnership 4 Health Care Atlanta, she brings a wealth of experience and expertise to her work.

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