1. Routine home care
Routine home care is the standard level, delivered wherever the patient lives. It includes scheduled nursing visits, aide visits for personal care, social work and chaplain support, medications and equipment related to the terminal diagnosis, and 24-hour telephone access to a nurse.
Visit frequency is based on the care plan and changes with the patient’s condition. Most hospice days in the United States are routine home care days.
2. Continuous home care
Continuous home care is for a short-term crisis: severe pain, uncontrolled nausea, agitation, or another symptom that requires a nurse to be present in the home for an extended period (generally at least eight hours in a 24-hour period) in order to keep the patient at home.
This is not round-the-clock bedside caregiving. It is skilled nursing care during an acute episode, and it usually lasts hours to a few days. When the crisis resolves, the patient returns to routine care. If it cannot be resolved at home, the next level may be needed.
3. General inpatient care
General inpatient care is for symptom management that cannot be provided in the home: uncontrolled pain, severe agitation, or other acute problems requiring continuous clinical monitoring. It is delivered in a hospital, a freestanding hospice facility, or a skilled nursing facility under arrangement with the hospice.
It is intended to be short-term: stabilize the symptom, then return the patient home or to a lower level of care. Medicare covers it when the criteria are met.
Hospices differ here: some operate a dedicated inpatient unit, and many arrange this level of care in a hospital or skilled nursing facility instead. Families often assume every hospice has its own unit. It is a fair question to ask any provider before admission.
4. Respite care
Respite care gives the family a break. The patient is admitted to a facility for up to five consecutive days per benefit period, primarily to relieve the caregiver rather than to treat a medical crisis.
Medicare covers respite care but requires a small coinsurance (currently 5% of the Medicare-approved amount), so it is not entirely without cost. Many families find it worth it, especially when a sole caregiver has been managing alone for months.
Ask the hospice social worker how respite is arranged, which facilities are used, and what the family will owe.
How patients move between levels
Level changes are clinical decisions made by the hospice team, usually the nurse in consultation with the medical director. Families can and should request a reassessment when something changes.
A useful script: “He has been much more agitated since last night and I cannot keep him safe. What level of care does this need?” That question invites a clinical answer rather than a reassurance.
At a glance
| Level | Where | Typical duration | Purpose |
|---|---|---|---|
| Routine home care | Home or care setting | Ongoing | Regular visits and symptom management |
| Continuous home care | Home | Hours to a few days | Short-term crisis requiring extended nursing |
| General inpatient | Hospital or facility | Days | Symptom control not possible at home |
| Respite | Facility | Up to 5 days | Caregiver relief |
Coverage rules and coinsurance apply differently at each level. Ask the hospice billing office to explain the specific costs before care begins.
Common questions
Does every hospice have an inpatient facility?
No. Many hospices do not own an inpatient unit. General inpatient care is arranged in a contracted hospital, hospice facility, or skilled nursing facility when a patient needs it.
How do I get continuous care for my mother at home?
Continuous care is authorized when a nurse documents an acute crisis requiring extended skilled nursing. Call the on-call nurse, describe the symptoms, and ask specifically whether the situation meets criteria for continuous care.
Is respite care free?
No. Medicare covers respite care but requires coinsurance of about 5% of the Medicare-approved amount, and there may be limits on which facilities are available.
Can a patient go back to routine care after inpatient care?
Yes, and that is usually the goal. Once symptoms are controlled, the patient returns home or to their prior setting with an updated plan.