Hospice: Levels of Care
Hospice: Levels of Care
Hospice includes 4 levels of care. A patient’s level of care is individualized based on patient or caregiver needs and the goals of care during the end-of-life journey.
If you or a loved one has been faced with a difficult terminal diagnosis, you’ve likely researched and discussed and spent many hours thinking about end-of-life care and goals of care. There are many decisions to make and plans to put in place. One of those is how to handle the end-of-life journey and what amount and type of care to receive: namely, Palliative Care or Hospice Care.
Both Palliative Care and Hospice Care focus on quality of life for both the patient AND their family. Both services are provided wherever the individual calls home – whether that be a hospital, nursing home, specialized clinics or family home. Additionally, both palliative care and hospice care will educate the patient and family on choices for medical care as well as social, emotional, and practical support, just with a different focus for the type of care and treatment goals.
To touch on the difference between the two, Palliative Care is provided along with curative treatment and may begin at the time of diagnosis. With time, if the doctor or palliative care team believes ongoing treatment for the serious illness is no longer helping, the palliative care team will discuss future care options.
With hospice, end-of-life care focuses on comfort care rather than curative treatment. Hospice is designed for those patients that choose not to continue to undergo certain treatments. Patients that begin hospice care understand that his or her terminal illness is not responding to medical attempts to cure or slow the disease’s progress, therefore the goals of care switch from curative to comfort care.
What many do not realize, is that hospice has 4 levels of care within its scope of service: Routine Home Care, General Inpatient Care, Continuous Home Care, and Respite Care.
Routine Home Care: This is the most common level of care in hospice. The patient is generally stable and symptoms, like pain or nausea, are adequately controlled. This care is provided in a nursing facility or home.
General Inpatient Care (GIP): GIP is a crisis-like level or care for short-term management of out-of-control patient pain and/or symptoms. This care is typically provided outside the home, in an inpatient setting at a medical facility like a hospital or skilled nursing facility.
Continuous Home Care: Much like GIP, Continuous Home Care is also crisis-like level of care; however, this is provided in the home with at least 8 hours of continuous care from the hospice team.
Respite Care: This is a temporary, up to 5 days, level of care provided in a nursing home, hospice inpatient facility, or hospital so that a family member or caregiver can take some time to recharge. This level of care is tied to caregiver needs, not patient symptoms.
While all four of these are levels of care offered by all hospice agencies, not all hospice agencies can provide these respite care within their own facilities. Some hospice agencies have a dedicated care team and hospice care center. Some hospice agencies partner with other facilities to provide patients with respite care.
Level of care is one of many things to consider when choosing a hospice provider. Patient and caregiver needs may impact the level of care a hospice provides. Some hospice agencies might not have patients that need a level of care beyond routine home care.
This may not impact you or your loved one, based on the levels of care needed during the individual end-of-life journey. Every individual’s journey is different. It is important to choose a hospice provider that aligns with your goals of care.
A good resource to compare hospice providers in your area is at Medicare Hospice Compare.