Hospice care is a specialized approach focused on providing comfort and quality of life for individuals facing a terminal illness, shifting focus from curative treatments to symptom management and psycho-social support. The Medicare Hospice Benefit covers four distinct levels of care designed to meet a patient’s evolving needs. General Inpatient Care (GIP) is one of these levels, representing an intensive, temporary intervention designed for crisis situations.
Defining General Inpatient Care (GIP)
General Inpatient Care is a level of hospice care intended for short-term, acute symptom management that cannot be safely or effectively provided in any other setting, such as the patient’s home. It functions as a stabilization tool, allowing the hospice interdisciplinary team to apply aggressive palliative interventions during a crisis. This care is defined by the requirement for 24-hour skilled nursing services in a dedicated inpatient environment.
The primary purpose of GIP is to gain rapid control over severe, unmanaged physical symptoms, not to provide long-term care or address non-medical issues like caregiver burnout. When a patient’s pain or other symptoms become so intense that home-based interventions are failing, GIP provides the necessary intensity of care. This focused care is temporary, centered on stabilizing the patient for a return to a less intensive care setting.
Clinical Qualification for GIP
GIP eligibility is based on acute medical necessity, specifically when a patient’s symptoms are uncontrolled and require continuous, skilled observation and intervention. Symptoms must be unstable, meaning routine adjustments to medication in the home setting have been attempted and proven ineffective in achieving comfort. This situation requires a level of nursing care only available in an inpatient setting, often involving complex medication delivery or frequent titration.
Examples of symptoms necessitating GIP include unmanageable pain requiring frequent, complex adjustment of narcotic dosing or specialized delivery methods like intravenous or subcutaneous infusions. Severe, intractable nausea and vomiting unresponsive to antiemetic medications can lead to dehydration and rapid decline. Uncontrolled respiratory distress (dyspnea), which causes extreme anxiety or air hunger, often requires the intensive environment of GIP for stabilization.
The need for continuous assessment is also a qualifying factor, such as in cases of acute, severe delirium with behavioral disturbance that poses a safety risk. A sudden, rapid decline requiring around-the-clock monitoring or a pathological fracture needing constant pain management adjustment also meet the criteria. The hospice interdisciplinary group, which includes a physician, must document the precipitating event and the failure of prior home-based interventions to justify this higher level of care.
GIP Location and Duration
GIP is provided in a facility setting that can meet the requirements for round-the-clock skilled nursing care. Approved locations include a Medicare-certified hospice inpatient unit, a contracted hospital bed, or a skilled nursing facility equipped to provide the required 24-hour Registered Nurse (RN) coverage. The facility must have the resources to deliver the intensive services outlined in the patient’s plan of care, excluding most private homes or assisted living facilities.
The fundamental characteristic of GIP is its temporary nature, as it is solely intended for symptom stabilization, not for long-term placement. While there is no official limit to the number of days a patient can remain on GIP, a stay is typically short, often lasting only a few days to a week. Once the acute symptoms are managed and the patient is comfortable, the goal shifts to discharging them from the inpatient unit and returning them to a lower level of hospice care.
Discharge planning begins immediately upon admission to GIP, emphasizing the short-term focus of the intervention. The patient is expected to transition back to Routine Home Care once their pain or symptoms are adequately controlled and can be managed effectively in their place of residence. The continuation of GIP must be justified daily through documentation demonstrating the ongoing need for the inpatient level of skilled nursing intervention.
GIP vs. Routine and Respite Care
General Inpatient Care must be distinguished from the other levels of hospice care, particularly Routine Home Care (RHC) and Inpatient Respite Care. Routine Home Care is the most common level of service, where the patient receives intermittent visits from hospice staff in their residence, such as a private home or nursing facility. RHC is appropriate when symptoms are stable and managed, allowing the patient to live comfortably with support from family and the hospice team.
In contrast, GIP is reserved for periods of acute clinical instability where symptoms are uncontrolled and require continuous, high-level skilled care that RHC cannot provide. The difference lies in the intensity and constancy of nursing presence, moving from intermittent visits in RHC to a facility with 24-hour RN availability in GIP. The patient’s symptoms must be the driving factor for GIP, necessitating a facility stay for medical intervention.
Inpatient Respite Care is also facility-based, but its intent is entirely different from GIP. Respite Care is provided solely to give the patient’s primary unpaid caregiver a temporary break from their duties.
A patient receiving Respite Care must have relatively stable symptoms, and the stay is limited by regulation, typically to a maximum of five consecutive days. GIP is not a service for caregiver relief and is only appropriate when the patient’s symptoms are unstable, acute, and require aggressive medical management.