Hospice care is a specialized approach designed to provide comfort and support for individuals with a terminal illness, shifting the focus from curative treatment to quality of life. Most hospice services are delivered in the patient’s home, known as Routine Home Care (RHC). When a patient experiences a severe medical crisis that cannot be safely managed at home, a higher level of service called General Inpatient Care (GIP) becomes necessary. GIP is a temporary, intensive intervention reserved for short-term symptom management that requires round-the-clock professional observation and care in a specialized facility.
General Requirements for Hospice Admission
Before any level of hospice care can be authorized, a patient must meet foundational eligibility criteria establishing the terminal nature of their illness. The primary requirement is certification from a physician and the hospice medical director that the patient has a prognosis of six months or less if the disease follows its expected course. This certification acknowledges that the medical condition is no longer responsive to curative treatments, and the patient’s goals have shifted to palliative care.
The patient must formally sign an election statement, choosing comfort-focused care under the hospice benefit. This choice means the patient understands and accepts the non-curative philosophy of hospice. Although the six-month prognosis is a certification benchmark, hospice benefits are provided for as long as the patient remains terminally ill, with recertification occurring at set intervals.
Criteria for Acute Symptom Management
Qualification for General Inpatient Care is based exclusively on the presence of an acute medical crisis unmanageable in the patient’s current setting. The goal of GIP is to provide aggressive symptom relief that necessitates skilled nursing and medical intervention beyond what can be safely provided at home. The patient’s symptoms must be severe, unstable, and require continuous observation by a registered nurse.
Uncontrolled pain requiring frequent medication adjustments and titration, often involving complex delivery methods, is a common reason for GIP admission. Severe, intractable nausea and vomiting that cannot be resolved with standard protocols is another qualifying crisis. Similarly, unmanageable respiratory distress, such as severe shortness of breath (dyspnea) refractory to standard treatments, may require intensive monitoring.
Other clinical situations that warrant GIP include:
- Severe agitated delirium, where confusion and behavioral issues pose a safety risk to the patient or others.
- Complications like pathological fractures, acute bleeding episodes, or rapidly advancing open wounds requiring complex, frequent skilled dressing changes.
The determining factor is the failure of less intensive interventions, such as Continuous Home Care, to stabilize the patient’s condition.
Coverage and Authorization Rules
The General Inpatient Care level is a covered benefit under the Medicare Hospice Benefit, governed by Title XVIII of the Social Security Act. For a GIP stay to be covered, the hospice provider must confirm and authorize that medical necessity criteria are met. This requires thorough documentation by the hospice interdisciplinary team detailing the acute symptoms, interventions attempted at home, and why the current setting cannot safely manage the crisis.
The GIP service must be provided in a Medicare-certified facility, such as a dedicated hospice inpatient unit, a hospital, or a skilled nursing facility contracted by the hospice. The hospice agency is responsible for the cost of the facility stay, medications, and all related services while the patient meets the GIP criteria. Medicaid and most private insurance plans follow similar medical necessity guidelines for coverage.
Documentation must be updated daily, with the hospice team continuously justifying the need for this high level of care by showing that acute symptoms persist. If a patient’s symptoms are medically stable, the GIP status is no longer justified, even if the patient remains in a facility. Coverage is tied to the clinical need for acute symptom management, not the physical location of the patient.
Managing the Inpatient Stay and Transition
The General Inpatient Care stay is designed to be a short-term intervention focused on the rapid stabilization of acute symptoms. While duration varies, GIP stays typically last only a few days, often three to five, until symptom control is achieved. The hospice interdisciplinary group reviews the patient’s status daily to assess the continued necessity for this intensive level of care.
Once crisis symptoms are effectively managed and stable, the patient no longer meets GIP criteria and must transition to a lower level of care. This transition involves discharge planning for the patient to return to Routine Home Care (RHC), the standard level of hospice service delivered in the patient’s residence. The hospice team coordinates necessary equipment, medications, and support for the return home.
GIP is distinct from Inpatient Respite Care, which is a planned, short-term stay designed solely to provide temporary relief for the primary caregiver. GIP is strictly a medical intervention for an uncontrolled crisis, not a means for long-term placement.