Patients receiving hospice services have different needs. Those needs can change over time and require more or less hands-on patient care. For its purposes, Medicare defines four specific levels of hospice care with each level meeting a specific need. The levels are:

Routine Home Care – This is the most common level of hospice care. It involves caring for the patient at his or her residence, whether a private residence, assisted living facility or nursing facility.

Continuous Home Care - Patient care is provided between 8 and 24 hours a day to manage pain and other acute symptoms. These services must be mostly nursing care but can be supplemented with caregiver and hospice aide services. The goal is to help a terminally ill patient remain at home during a pain or symptom crisis.

General Inpatient Care - When the patient has uncontrollable pain or other acute symptoms that can't be managed at home, inpatient care may be needed. This care can be provided in a Medicare certified hospital, hospice inpatient facility or nursing facility that has registered nursing staff available 24 hours a day for direct patient care.

Respite Care - This type of hospice care allows a patient to stay in a hospital or other inpatient setting to provide temporary relief to a primary caregiver. Respite can take place in a continuum care hospice, hospital, hospice facility, or a long term care facility that has nursing personnel present on all shifts to meet a patient’s needs. Respite care is only provided for a maximum of five consecutive days (NHPCO, 2012).