Hospice care focuses on comfort and quality of life for individuals facing a life-limiting illness, managing symptoms rather than seeking a cure. Whether a hospice nurse remains overnight depends entirely on the setting and the specific Level of Care required. Continuous, overnight nursing is not a standard feature of every hospice plan. It is reserved for situations requiring intensive, short-term skilled intervention when a higher presence is medically necessary.
Routine Home Care: Scheduled Visits and On-Call Support
Routine Home Care (RHC) is the most common form of hospice service, used by over 95% of patients in their private homes, assisted living facilities, or nursing homes. Under this model, nurses do not stay overnight. Care is delivered through intermittent, scheduled visits from the hospice team, including nurses, aides, social workers, and chaplains. The frequency of these visits is determined by the patient’s individual care plan.
The absence of a continuously present nurse is offset by a robust 24-hour on-call system. Hospice nurses are on call around the clock, including nights, weekends, and holidays, to triage phone calls and address urgent medical concerns. The on-call nurse assesses the situation over the phone and may coach the family caregiver through symptom management. If necessary, the nurse may dispatch an emergency nighttime visit to the patient’s location.
This on-call system ensures a registered nurse or licensed practical nurse is available to respond to sudden changes in condition, such as uncontrolled pain or respiratory distress. The goal of the emergency visit is to stabilize the patient, adjust medications, and provide comfort measures so the patient can remain at home. The hospice nurse leaves once the immediate crisis is managed and the patient is stable, returning the care structure to the routine, intermittent schedule.
Continuous Home Care: Criteria for 24/7 Crisis Care
Continuous Home Care (CHC) is the specific level where hospice staff, including nurses and aides, provide extended, continuous care in the patient’s home, often around the clock. This level is strictly reserved for acute, temporary medical crises that cannot be managed by Routine Home Care visits. The patient must be experiencing uncontrolled symptoms, such as intractable pain or acute respiratory distress, requiring continuous skilled nursing observation and intervention.
To qualify for reimbursement, a minimum of eight hours of care must be provided within a 24-hour period, with nursing staff delivering at least 50% of that total care. The hospice team works in shifts, providing continuous bedside monitoring and administering frequent interventions like medication adjustments or specialized treatments. This continuous presence is intended to manage the immediate crisis and stabilize the patient’s symptoms quickly.
CHC is a short-term intervention, often lasting only a few days until the patient’s symptoms are successfully controlled and the acute crisis is resolved. Once symptoms are stabilized, the patient is transitioned back to the Routine Home Care level, and the continuous overnight nursing presence ends. This specialized care is designed to prevent an unnecessary hospital transfer and allow the patient to remain comfortably at home.
Overnight Nursing in Inpatient and Residential Facilities
For patients whose symptoms cannot be managed effectively or safely at home, 24/7 nursing is a standard requirement. General Inpatient Care (GIP) is provided in a dedicated hospice inpatient unit, a contracted hospital, or a skilled nursing facility when severe symptoms necessitate a higher level of medical management. In these facilities, registered nurses are required to be present on-site around the clock to provide direct, continuous patient care.
These inpatient units are equipped for short-term, acute symptom management, such as stabilizing severe delirium, administering complex intravenous medications, or controlling rapidly escalating pain. The continuous presence of a nursing team ensures immediate response to changes in the patient’s condition. Patients remain at this level only until their symptoms are successfully managed.
Residential Hospice Facilities
Residential hospice facilities, which may be small, home-like settings, also maintain a continuous staff presence for comfort and support. While the medical requirements for residential care are less acute than General Inpatient Care, the facility ensures that nursing staff is available 24 hours a day to oversee care. The “overnight nurse” is a consistent part of the staffing model, providing continuous assistance, though the cost of room and board is typically not covered by the hospice benefit.