Hospice care is a specialized form of medical support for individuals facing a life-limiting illness. It focuses on comfort and quality of life rather than curative treatments. This philosophy centers on managing symptoms, providing emotional and spiritual support, and honoring the patient’s wishes. The four distinct levels of care are defined and funded primarily by the Medicare Hospice Benefit in the United States. These levels are non-linear service models designed to meet the changing clinical needs of the patient and the support needs of their family.
Routine Home Care
Routine Home Care (RHC) is the most frequently utilized level of hospice service and represents the standard model of care delivery. This level is for patients who are medically stable and whose symptoms, such as pain or nausea, are adequately controlled with intermittent support. Care is provided wherever the patient resides, which may be a private home, an assisted living facility, or a nursing home.
The RHC model involves scheduled, periodic visits from an interdisciplinary team, including registered nurses, social workers, spiritual counselors, and home health aides. The team focuses on pain and symptom management, assistance with activities of daily living, and providing psychosocial support for the patient and family. All necessary medications, medical equipment, and supplies related to the terminal diagnosis are covered. While a hospice nurse is available 24 hours a day for consultation, RHC does not provide round-the-clock nursing presence in the home.
Continuous Home Care
Continuous Home Care (CHC) is a temporary, crisis-management level of service intended to stabilize acute medical symptoms that cannot be managed with routine visits. This level is activated during a medical crisis, such as uncontrolled pain, severe respiratory distress, or persistent nausea and vomiting. The goal is to provide intensive support to keep the patient comfortable in their home environment.
To qualify for a CHC day, the patient must receive at least eight hours of direct care within a 24-hour period. This care must be predominantly skilled nursing care, meaning that a registered or licensed practical nurse must provide more than 50% of the total care hours. Skilled nursing is provided for the duration of the crisis, involving frequent medication adjustments and intense monitoring. Once the acute symptoms are successfully managed and the patient is stabilized, the service transitions back to Routine Home Care.
Inpatient Respite Care
Inpatient Respite Care (IRC) focuses primarily on supporting the caregiver, rather than the patient’s acute medical needs. This care is designed to provide a short-term break for the primary caregiver, allowing them time to rest or attend to personal matters. The patient’s clinical condition must be stable to receive this level of care.
IRC is provided in an approved institutional setting, such as a Medicare-certified hospital, a skilled nursing facility, or a dedicated hospice inpatient unit. The benefit typically covers the patient’s stay for up to five consecutive days. During this period, the hospice team continues to follow the established care plan, ensuring the patient receives all necessary support while the family caregiver is relieved of their duties.
General Inpatient Care
General Inpatient Care (GIP) is reserved for the most severe and acute symptom management needs when a patient’s condition cannot be effectively controlled in any other setting. It is an intensive, short-term measure for issues like intractable pain, sudden pathological fractures, or acute respiratory distress that requires a higher level of medical intervention. GIP necessitates admission to a hospital or a licensed hospice inpatient facility that can provide 24-hour skilled nursing observation and physician oversight.
This level of service is initiated only when all efforts to manage the symptoms in the patient’s home environment, including Continuous Home Care, have been unsuccessful. The purpose of GIP is to achieve rapid palliation of symptoms. As soon as the acute symptoms are stabilized and under control, the patient is discharged from GIP and returns to Routine Home Care.