Hospice Levels of Care

Regular visits are made to the patient at their home, assessing their needs and implementing the plan of care to support their needs related to the terminal prognosis. Routine care is provided where the patient lives, which can include a home, skilled nursing facility (SNF) or assisted living facility (ALF).

The respite level of care is utilized to give the primary caregiver of a patient a “break” and is only utilized in a hospice inpatient facility, SNF or hospital with 24-hour nursing services. A contract is required with the facility in which the respite is taking place. The hospice is to provide additional education to staff and provide visits to the patient as scheduled. Respite is limited to 5 consecutive nights. Respite is not an emergency service, but a planned break.

The continuous care level of care is initiated to provide uncontrolled symptom management in the home, ALF or independent living facility. For a hospice to bill for continuous care, 8 hours of care within a 24-hour period (starting at midnight) must occur. Only nursing and aide services are counted in these hours, and more than 50% of the care must be provided by an RN or LPN; the other half can be provided by home health aides. The goal of continuous care is to provide the necessary skilled nursing services to resolve the symptom and discharge the patient back to the routine level of care.

• Uncontrolled pain
• Unmanageable dyspnea
• Acute agitation and delirium
• Severe anxiety/suicidal ideation/psychosis
• Intractable nausea/vomiting
• Hemorrhagic bleeding (CNS, respiratory, GI, GU, cutaneous)
• Uncontrolled grand mal seizures
• Severe infection (sepsis, GI/colitis, meningitis)
• Imminent death – only if pain and/or other symptoms are not managed, and intensive skilled nursing is needed

Patients can utilize the GIP level of care when they have an uncontrolled symptom. GIP is an emergency service intended to resolve symptoms that are unable to be controlled in the home environment. It is utilized in SNF and hospital settings, and a contract is required. GIP requires 24-hour RN presence providing direct patient care and the hospice is required to provide additional education to staff. The goal of GIP is always to discharge back to routine care once symptoms are resolved. Daily nursing visits and detailed documentation justifying the need for the GIP level of care is required.

• Uncontrolled pain
• Unmanageable dyspnea
• Acute agitation and delirium
• Severe anxiety/suicidal ideation/psychosis
• Intractable nausea/vomiting
• Hemorrhagic bleeding (CNS, respiratory, GI, GU, cutaneous)
• Uncontrolled grand mal seizures
• Severe infection (sepsis, GI/colitis, meningitis)
• Imminent death – only if pain and/or other symptoms are not managed, and intensive skilled nursing is needed