What Are The Four Levels Of Hospice Care?

As an illness progresses, your loved one's needs increase. You may only be able to care for their needs occasionally, but they need full-time care. What can a family caregiver do? Emotional and financial stress can become overwhelming for family caregivers. Fortunately, hospice care can provide support.

Hospice care is a form of healthcare that provides support and comfort to individuals in the final stages of a terminal illness or near the end of their life. The primary goal of hospice care is to improve the quality of life for patients and their families by managing symptoms and providing emotional, spiritual, and psychosocial support.

Understanding the stages of end-of-life care

End-of-life care is a comprehensive approach that addresses individuals with terminal illnesses' physical, emotional, and spiritual needs. This care journey typically encompasses three main stages:

1. Diagnosis and decision-making:

• Diagnosis: The end-of-life care process begins with a medical diagnosis of a terminal illness. This phase involves a series of medical tests, evaluations, and discussions with healthcare providers to determine the prognosis. Patients and their families are informed about the seriousness of the illness and the limited life expectancy.
• Decision-making: Patients and their families engage in critical discussions regarding care options during this stage. These conversations revolve around medical treatments, the management of symptoms, and the patient's priorities for their remaining time. Advance care planning, including creating advance directives, is significant in outlining the patient's wishes.

2. Living with dying:

• Managing symptoms: The "living with dying" stage focuses on managing symptoms and maximizing comfort as the patient's illness progresses. This period can extend for an unpredictable duration. The care team, including physicians, nurses, and hospice professionals, collaborates to address pain, discomfort, and other distressing symptoms.
• Communication: Ongoing communication is paramount during this stage to ensure that care aligns with the patient's evolving values and needs. Regular assessments are conducted to adjust the care plan as required.
• Support services: Patients and their families may receive various support services, such as palliative treatments, counseling, social support, and spiritual guidance. These services are designed to help patients live as fully as possible despite their illness.

3. Preparing for end-of-life:

• Hospice services: As the illness progresses and the patient's condition declines, the focus shifts to preparing for the end of life. This is when hospice services often become involved. Hospice care emphasizes comfort, dignity, and a natural death. Patients may transition to receiving hospice care in their home, a hospice facility, or an inpatient hospice unit within a hospital.
• Changing priorities: During this stage, priorities shift to spending quality time with loved ones, engaging in life review, and finding meaning and peace. Hospice professionals support the patient and family members through this emotionally challenging period.
• Closure and comfort: The goal is to provide closure and comfort, ensuring that the patient's end-of-life experience is as peaceful and dignified as possible. This stage may involve discussions about final wishes, memorial planning, and saying meaningful goodbyes.

Understanding these stages can guide patients and their families through the end-of-life journey. Each stage can vary widely from person to person, and the process should be tailored to meet the unique needs, values, and preferences of each individual and their family.

The four levels of hospice care

There are four different levels of hospice care as defined by Medicare. The right level depends on the patient's needs and condition. For example, does your loved one need round-the-clock care? Can they care for their basic needs like cooking, dressing, or showering? Is your loved one a danger to themself or prone to falling without assistance? As a caregiver, do you need a temporary break to refresh yourself and care for your family? What choices do you have?

Hospice care options include: 

1. Routine Home Care: This is the most frequently provided level of hospice care, usually for relatively stable patients with well-controlled symptoms like pain or nausea. Typically administered in the patient's home.
2. General Inpatient Care: Reserved for crises when a patient's pain or symptoms are unmanageable in a home setting, necessitating short-term, intensive care. Delivered in a medical facility like a hospital or skilled nursing facility, not in the patient's home.
3. Continuous Home Care: Similar to general inpatient care, it is used for managing severe pain or symptoms that are out of control, but it's provided within the patient's home. Designed for short-term, crisis-like situations.
4. Respite Care: A temporary level of care mainly intended to give a break to the family member or friend serving as the patient's caregiver. This level of care is based on the caregiver's needs, not solely on the patient's symptoms. It can be provided in a nursing home, hospice inpatient facility, or hospital.

How do you put someone in hospice?

Putting someone in hospice care involves several steps, and it typically begins with a discussion between the patient, their family, and their healthcare team. Here's a general outline of the process:

1. Consult the healthcare team: Talk to the patient's healthcare team, who will assess hospice eligibility based on their terminal illness.
2. Select a provider: Choose a reputable hospice provider with recommendations from the healthcare team.
3. Referral and assessment: The healthcare team initiates a referral, and the hospice agency assesses the patient's eligibility.
4. Custom care plan: The hospice team works with the patient and family to create a personalized care plan, focusing on symptom management and goals.
5. Consent forms: Sign consent forms to agree to the hospice care plan.
6. Choose care setting: Decide on the care setting, which can be at home, in a hospice facility, nursing home, or hospital-based unit.
7. Receive ongoing care: The hospice team provides continuous care, managing symptoms, offering emotional support, and addressing needs.
8. Regular assessments: The patient's condition is regularly evaluated to adjust the care plan as needed.
9. Bereavement support: After the patient's passing, hospice providers offer bereavement support for family members.

Do both Medicare and Medicaid cover all four types of hospice care?

Both Medicare and Medicaid provide coverage for hospice care, but there are differences in the services they cover and eligibility requirements. Here's a breakdown of the similarities and differences between Medicare and Medicaid when it comes to covering the four types of hospice care:

Both Medicare and Medicaid cover routine home hospice care, which is the most common form of hospice provided in a patient's home or care facility.

However, some of the differences include:

1. Eligibility: Medicare is primarily available to individuals 65 and older and those with specific disabilities. Conversely, Medicaid is a joint federal and state program that provides coverage to low-income individuals and families. Eligibility criteria and income limits for Medicaid vary by state.
2. Inpatient respite care: Medicare covers up to five days of inpatient respite care in a hospital, hospice facility, or nursing home as a part of the hospice benefit. Medicaid's coverage of inpatient respite care can vary by state, and the duration and criteria may differ.
3. General inpatient care: Medicare covers general inpatient care provided in a hospice facility, hospital-based hospice unit, or nursing home. Medicaid typically covers this level of care, but specific requirements and facility choices can differ by state.
4. Continuous care: Both Medicare and Medicaid cover continuous care when medically necessary, but the criteria for determining medical necessity may vary between the two programs.
5. Beneficiary costs: Under Medicare, beneficiaries generally do not have to pay for hospice services, but they may have a small copayment for certain prescription drugs. Medicaid may have some cost-sharing requirements, such as copayments for certain services, but these fees are typically lower for hospice care than other types of care.
6. Access to hospice providers: Medicare beneficiaries have access to all Medicare-certified hospice providers, while Medicaid beneficiaries may have access to a different set of hospice providers based on their state's Medicaid program.

Both Medicare and Medicaid have specific rules and guidelines for hospice care. Patients and their families should work closely with their healthcare providers and the hospice team to understand the coverage provided by these programs and ensure that the care received aligns with their specific needs and circumstances. Medicaid rules vary from one state to another, so it's essential to check with the local Medicaid office for detailed information.

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Related: Caregiver Checklist: What to Do When Your Parent Dies >>