Hospice care provides comfort-focused support for individuals with a serious illness, shifting the medical goal from curative treatment to pain relief and symptom management. This specialized care is delivered by an interdisciplinary team, including nurses, physicians, social workers, and spiritual counselors. While most commonly provided at home, hospice services are also available in various facilities, such as hospitals, nursing homes, and dedicated inpatient units.
Qualifying for the General Hospice Benefit
Accessing hospice care begins with an eligibility requirement set by the primary payer, typically the Medicare Hospice Benefit. A patient must first be certified as terminally ill by both the attending physician and the hospice medical director. This certification formally states that the patient has a prognosis of six months or less if the illness runs its normal course.
This initial certification establishes the overall timeline for the hospice benefit, which is structured into specific periods of coverage. The six-month prognosis must be confirmed before any hospice services can begin, regardless of where the patient receives care.
Criteria for Admission to Inpatient Hospice Care
Inpatient hospice care, known as General Inpatient Care (GIP), is a specific level of service designed for short-term, acute symptom management, not long-term residence. A patient is admitted to GIP only when their pain or other acute symptoms cannot be managed effectively in any other setting, such as their home or a skilled nursing facility. This service is a temporary intervention used to stabilize a crisis.
The criteria for GIP are highly specific and focus on the medical necessity of 24-hour skilled care. Examples include uncontrolled pain requiring frequent medication titration, severe respiratory distress, or acute delirium with agitation that poses a safety risk. The goal is to aggressively manage these symptoms until they are stabilized, at which point the acute need for GIP ends.
The length of stay is dictated entirely by the patient’s acute medical status, not a fixed number of days. Stays are generally brief, often lasting only a few days to a week until symptoms are controlled. Once stabilization occurs, the patient must transition back to a routine level of care.
Managing the Length of Stay and Recertification
The overall hospice benefit is structured into periods that can last much longer than any single inpatient stay. The initial benefit consists of two 90-day periods, followed by an unlimited number of subsequent 60-day periods. At the start of each new benefit period, a physician must recertify that the patient continues to meet the six-month prognosis requirement.
The inpatient stay is continuously evaluated daily by the hospice team. The team must document the ongoing need for General Inpatient Care to justify the continued use of this intensive level of service. If the acute symptoms abate, the medical necessity for the inpatient facility ends, regardless of the time remaining in the current benefit period.
Moving Back to Home Hospice or Discontinuing Care
The successful management of acute symptoms during a GIP stay triggers a planned transition back to routine home care (RHC). The patient is transferred back to their primary residence or facility once the hospice team determines their pain and symptoms can be managed in that setting. Discharge planning for this transition begins immediately upon admission to the inpatient unit.
If a patient’s condition stabilizes or improves so they no longer meet the terminal prognosis criteria, they are formally discharged from hospice care. Alternatively, a patient may choose to discontinue the hospice benefit at any time by signing a revocation statement, often to pursue curative treatment.