Hospice care is a service given to a terminally ill patient or anyone given a prognosis of six months or less to live by a medical doctor. Also considered end-of-life care, or comfort care, Medicare has defined hospice services as made up of four levels of care. Not all hospice patients need or receive all four levels of hospice care. One patient may only use one level, while another may go through all four levels in a week or less. Each hospice patient goes through their own unique journey.
Level 1: Routine Home Care
This is the most basic level of medicare certified hospice care. It exists for patients living at home, have been confirmed eligible for hospice care by a medical doctor, and qualify for Medicare Part A and B. The majority of patients who receive 90 days of hospice care or more are getting this type of hospice care. This level of hospice is usually appointment-based and includes such services as:
- Physical therapy
- Occupational therapy
- Intermittent skilled nursing services
- Durable medical equipment
- Part-time use of a home health aide
- Medical supplies for home use
At this level of hospice, you don’t have access to 24/7 care. However, many centers for medicare and hospice agencies keep a nurse on-call at all times for families that have urgent needs.
Level 2: Continuous Home Care
Continuous care is the second of the four levels of hospice care. It is usually used in times of crisis. We elevate patients that require continuous care for a minimum of eight hours straight, within a 24 hours to manage acute symptoms, into this hospice care level of care. Continuous home care may cover such symptoms as:
- Severe nausea
- Vomiting
- Unrelieved pain
- Heightened anxiety or panic attacks
- A change in primary caregiver support at home
If a hospice patient has symptoms that cannot be controlled, level 2 hospice care allows a nurse to stay with the family as long as necessary until the patient is comfortable. Level 2 can also assist in cases where the person is actively dying.
Level 3: General Inpatient Care
Sometimes patients may experience symptoms so extreme that they cannot receive adequate hospice and palliative care at home. Or sometimes they feel more comfortable at a certified hospice care facility. General inpatient care gives a patient access to palliative care 24-hours a day, and can be done at a nursing home, assisted living facility or other hospice facility. Some patients with a terminal illness prefer an inpatient facility because it eases the responsibility of family caregivers and allows them to simply be there for emotional support. A nursing facility can administer sufficient pain relief and medications along with emotional support for everyone during a difficult time. This doesn’t mean that an inpatient facility gives a better level of care than intermittent or routine home care. Every patient is different and needs to take advantages of the services that best suit their wishes and needs.
Level 4: Respite Care
You shouldn’t underestimate the stress of being a primary caregiver. While many of them would not have it any other way, taking care of someone who is nearing the end of their life is an around the clock job. Medicare understands that sometimes, for many reasons, people need to take a break, or step back from giving their loved one constant care. With respite care, we can admit a patient to a 24-hour nursing facility on a temporary basis. Which gives a caregiver time to take care of their own physical and emotional needs. Not everyone needs this hospice benefit, but respite care can be a lifesaver to caregivers who do not have enough help or support.
Who Determines The Levels of Hospice Care?
Anyone who qualifies for hospice has a team that consists of both the patient’s personal doctor and a hospice doctor. The levels of hospice care a person qualifies for falls under the responsibility of the hospice physician. The most important thing is that with these four levels of hospice care in place, a patient may always be able to get the care they need to live out their lives in a calm and peaceful manner.
If you have any questions about our hospice care services here at Mary T, send us a message or give us a call.