Hospice can be both inpatient and outpatient, but the vast majority of hospice care happens at home. According to 2024 Medicare data, 98.8% of all hospice days are billed as routine home care. Inpatient hospice exists, but it’s reserved for specific short-term situations like uncontrolled pain or caregiver relief. Understanding the four levels of hospice care helps clarify when each setting applies.
Most Hospice Care Happens at Home
Routine home care is by far the most common level of hospice. The patient lives at home (or in a nursing home or assisted living facility they already call home), and a hospice team visits on a regular schedule. Nurses, aides, social workers, and chaplains rotate through, but the patient isn’t staying in a medical facility. Medications for pain and symptom management are covered, with a copay of up to $5 per prescription.
This is the level of care most people picture when they think of hospice. The patient is generally stable, symptoms like pain or nausea are under control, and the focus is on comfort rather than cure. Family members or friends typically provide the day-to-day caregiving between visits from the hospice team.
When Hospice Moves to an Inpatient Setting
Hospice shifts to an inpatient facility when symptoms become unmanageable at home. This level is called General Inpatient Care, and it’s specifically for crisis situations: pain that can’t be controlled, severe breathing difficulty, intractable nausea, or other acute symptoms that need round-the-clock medical attention. The key requirement is that the symptom management couldn’t be achieved in any other setting.
General Inpatient Care is short-term by design. Once symptoms are stabilized, the patient transitions back to routine home care. It takes place in hospitals, skilled nursing facilities, or dedicated hospice inpatient units that have contracts with the hospice program. Despite being a critical safety net, General Inpatient Care accounts for only 0.8% of all hospice days nationally, and that percentage has stayed flat or declined slightly in recent years.
Continuous Home Care: Crisis Care Without Leaving Home
There’s a middle option that many families don’t know about. Continuous home care provides intensive, crisis-level support in the patient’s own home. It’s meant to prevent hospitalization during a symptom crisis by sending nurses and aides to stay with the patient for extended hours. Think of it as bringing the intensity of inpatient care into the home setting.
This level is rarely used, accounting for just 0.1% of hospice days. It’s only available during brief crisis periods and serves as an alternative to transferring the patient to a hospital or inpatient hospice unit. Once the crisis resolves, care drops back to the routine home care level.
Inpatient Respite Care: A Break for Caregivers
The fourth level of hospice is unique because it’s based on caregiver needs, not the patient’s symptoms. Inpatient respite care temporarily moves the patient to a nursing home, hospital, or hospice inpatient facility so the primary caregiver can rest. Caring for a terminally ill loved one at home is physically and emotionally exhausting, and respite care exists to prevent caregiver burnout.
Respite stays are capped at five consecutive days (counting the admission day but not the discharge day). If the patient stays beyond five days, the billing reverts to the routine home care rate. You may pay 5% of the Medicare-approved amount for respite care, though your copay can’t exceed the inpatient hospital deductible. This level makes up about 0.3% of hospice days.
Where Inpatient Hospice Takes Place
When a patient does need inpatient-level hospice, there are three types of facilities where it typically happens. Hospitals can provide General Inpatient Care through a contract with the hospice program, using a regular hospital bed with the hospice team directing the plan of care. Skilled nursing facilities work similarly, offering a bed and nursing support while the hospice agency remains in charge of the patient’s comfort-focused treatment.
The third option is a freestanding hospice inpatient unit, sometimes called a hospice house. These are standalone facilities designed specifically for end-of-life care, with a more homelike atmosphere than a hospital. They tend to allow more flexible visiting hours and accommodate families who want to stay overnight. Not every community has one, so availability varies by region.
How Patients Move Between Levels
Hospice care isn’t locked into one setting. Patients can move between levels as their needs change, and the hospice team makes these transitions based on what’s happening clinically. A patient on routine home care whose pain suddenly spikes might be moved to General Inpatient Care for a few days, then return home once the pain is under control. A family caregiver nearing exhaustion might arrange a five-day respite stay, after which the patient comes home and routine visits resume.
The hospice program coordinates all of this. You don’t need to re-enroll or find a new provider when shifting between levels. Medicare covers all four levels under the same hospice benefit, though the daily reimbursement rates differ significantly. For fiscal year 2026, Medicare pays about $231 per day for routine home care in the first 60 days, compared to roughly $1,200 per day for General Inpatient Care and $532 per day for respite care. These rate differences reflect the intensity of resources involved, but patients are largely shielded from these costs.
What This Means for Your Situation
If you or a family member is considering hospice, expect care to be primarily home-based. That’s the default and the most common experience by a wide margin. Your home becomes the care setting, and the hospice team comes to you. Inpatient hospice is available when it’s genuinely needed, but it’s the exception rather than the rule.
When evaluating hospice programs, it’s worth asking which inpatient facilities they contract with for General Inpatient Care and respite stays. Some programs have access to dedicated hospice houses, while others rely on hospital beds or nursing homes. The quality of that inpatient option matters, even if you hope never to need it.