Hospice care focuses on comfort and quality of life for individuals with a terminal illness, rather than pursuing curative treatments. While most patients receive care at home (Routine Home Care), four distinct levels of care meet varying needs. The General Inpatient (GIP) level is a specialized service intended for short-term, acute symptom management. GIP is activated only when a patient’s symptoms become so severe and complex that they cannot be managed effectively in a home setting.
Defining the General Inpatient Level of Care
General Inpatient Care (GIP) is not the routine model of hospice service; it represents a temporary, higher intensity of care. The defining characteristic of GIP is the requirement for continuous professional nursing and physician oversight. This level of care is designed for the rapid and aggressive management of symptoms that have become uncontrolled or difficult to stabilize.
GIP care cannot be provided in a patient’s private residence or an assisted living facility. It is delivered in specialized locations that meet federal requirements for intensive inpatient care. These settings include freestanding Medicare-certified hospice units, dedicated hospice units within hospitals, or certain skilled nursing facilities contracted with the hospice provider. The facility must ensure 24-hour availability of registered nurses to provide direct patient care, a staffing intensity distinct from Routine Home Care.
The intent of GIP is to provide an environment with immediate access to all necessary resources to stabilize a patient’s medical crisis. The facility setting allows for quicker changes in medication delivery, continuous patient monitoring, and immediate intervention by the interdisciplinary team. This intensive environment ensures the patient’s acute needs are met before they can safely return to a less restrictive level of care.
Medical Necessity for Admission
Admission to the General Inpatient level of care is governed by medical necessity criteria, serving as a crisis management tool for acute symptom exacerbations. The core justification for GIP is the presence of severe, uncontrolled pain or other acute symptoms that cannot be managed effectively at home or in any other setting. The patient’s condition must require an intensity of care that exceeds what can be delivered by intermittent visits from a hospice nurse.
Specific clinical situations trigger the need for GIP, such as severe, intractable pain requiring frequent medication titrations and complex delivery mechanisms like intravenous or subcutaneous infusions. Uncontrolled symptoms like acute respiratory distress, relentless nausea and vomiting leading to dehydration, or severe seizures unresponsive to standard home treatments also justify this level of care. Furthermore, conditions such as pathological fractures or sudden, severe delirium that poses a risk to the patient or others necessitate the intensive monitoring found in a GIP setting.
The decision to admit a patient to GIP status must be formally determined by the hospice physician or medical director, in collaboration with the interdisciplinary group. Documentation must clearly show the precipitating event—the onset of uncontrolled symptoms—and the interventions attempted at home that failed to achieve symptom control. GIP is not a residential option and is not appropriate when the need for admission is solely due to caregiver exhaustion or a breakdown in home support.
Core Services Provided During an Inpatient Stay
Once a patient is admitted under GIP status, the focus shifts to continuous medical intervention aimed at achieving symptom stabilization and comfort. This includes rapid adjustments to pain and symptom management protocols, often involving sophisticated medication techniques such as continuous subcutaneous or intravenous therapies. The goal is to quickly bring the patient’s symptoms, such as pain, shortness of breath, or agitation, under control.
The interdisciplinary team is actively involved in the patient’s care, with registered nurses providing direct care and monitoring around the clock. The team includes physicians, social workers, spiritual counselors, and bereavement specialists who address the patient’s and family’s holistic needs. Complex treatments, such as advanced wound care or the management of acute bleeding, are performed using the facility’s extensive resources and staffing.
In addition to physical medical services, the GIP environment provides intensive emotional and psychosocial support for the patient and family during a period of crisis. Social workers and chaplains offer counseling to help families navigate the sudden decline and associated distress. The intent of these services is not only to stabilize the medical condition but also to restore comfort and dignity, preparing the patient for discharge to a lower level of care.
Financial Coverage and Duration of Care
The General Inpatient level of care is a covered benefit under Medicare, Medicaid, and most private insurance plans, provided the criteria for medical necessity are met. Medicare beneficiaries generally face no deductible or copayment for GIP services. However, Medicare does not cover room and board costs if the patient is a permanent resident of a facility like a nursing home. The hospice agency receives a significantly higher daily reimbursement rate for GIP compared to Routine Home Care, reflecting the intensity of services provided.
GIP is explicitly designed to be a temporary intervention. The stay is intended to last only until the acute, uncontrolled symptoms are stabilized or managed effectively. While there is no fixed time limit, GIP stays are typically short, often lasting only a few days to a week.
As soon as the patient’s condition is stable and symptoms are controlled, the hospice team plans for discharge back to a less intensive level of care. This usually means a return to Routine Home Care at their residence, or, in some cases, a transfer to a long-term care facility with continued hospice services. This transition ensures that high-intensity GIP resources are reserved for patients experiencing an active medical crisis.