Hospice care is a specialized form of palliative care for individuals with a terminal illness, typically when a doctor estimates a prognosis of six months or less. This approach shifts the focus from curative treatment to managing pain and other symptoms, supporting the patient’s physical, emotional, and spiritual needs. While people often refer to the process using the phrase “3 stages of hospice care,” the service is formally structured around four distinct Levels of Care as defined by federal regulation, specifically the Medicare Hospice Benefit. These federally recognized levels ensure patients receive appropriate care as their needs change.
Routine Home Care
Routine Home Care (RHC) is the level of service provided most frequently. This care is centered in the patient’s place of residence, which can be a private home, an assisted living facility, or a nursing home. RHC is designed for patients whose symptoms are generally stable and managed, allowing them to remain in a familiar environment.
RHC is delivered by an interdisciplinary team that includes nurses, hospice aides, social workers, and chaplains. Hospice nurses and aides make scheduled visits to provide skilled medical oversight, pain management, and assistance with activities of daily living like bathing and dressing. All necessary medications, durable medical equipment, and supplies related to the terminal illness are covered. The goal is proactive symptom management and maintenance of the patient’s comfort and quality of life.
Crisis Management: Continuous and Inpatient Care
When a patient experiences a temporary medical crisis where symptoms become acute and unmanageable at home, hospice provides two high-acuity levels of care: Continuous Home Care (CHC) and General Inpatient Care (GIP). These two levels are temporary responses to severe, uncontrolled symptoms like sudden respiratory distress, uncontrollable pain, or severe nausea and vomiting. The distinction between them is primarily the location and intensity of the necessary care.
Continuous Home Care (CHC) involves intensive nursing care delivered in the patient’s residence for a period of between eight and 24 hours per day. This service is initiated specifically to manage a medical crisis and provide continuous monitoring and skilled intervention to stabilize the patient. The goal is to bring the symptoms under control quickly so the patient can return to the stability of Routine Home Care.
If symptoms cannot be safely or effectively managed in the home, the patient may be temporarily admitted to General Inpatient Care (GIP). GIP is provided in a Medicare-certified facility, such as a dedicated hospice inpatient unit, a hospital, or a skilled nursing facility. This level provides 24-hour nursing and physician support for acute symptom stabilization that requires a higher level of medical resources than can be provided at home. GIP is intended to be short-term; once the acute symptoms are stabilized, the patient is discharged back to a lower level of care, typically RHC.
Caregiver Relief: Respite Services
Inpatient Respite Care (IRC) is the fourth distinct level of hospice service. The primary beneficiary of this service is the unpaid primary caregiver, not the patient’s acute medical needs. Providing round-the-clock care for a terminally ill loved one is physically and emotionally demanding, and respite care is designed to prevent caregiver burnout.
The service involves admitting the patient to a Medicare-approved facility, such as an inpatient hospice unit, a hospital, or a skilled nursing facility, for a brief period. Federal regulations typically limit this stay to a maximum of five consecutive days and nights at a time. The patient’s symptoms do not need to be unstable or uncontrolled to qualify. This temporary relief allows the caregiver to attend to personal needs and recharge while the patient continues to receive high-quality hospice care.