When a loved one receives a life-limiting illness, know that your family has options available to help alleviate your relative’s pain with hospice care. While crafting a care plan, make sure you choose the right level of hospice care to fully address your loved one’s needs and give them the best quality of life possible.
Which Senior Care Services are Right for Your Loved One?
Learning more about your senior care options can help your family make the best choice for your unique situation. Popular options for senior care that are not residential care include:
- Hospice care
- Palliative care
- Home health care
About Hospice Care
Hospice care, as defined by Medicare, has four distinct levels of care designed to meet the varying needs of patients and their families as they near the end of life. A patient may experience all four levels or only one, depending on their individual circumstances.
Hospice patients can receive care in a home setting or in an inpatient facility, depending on the patient’s needs, insurance coverage, and wants.
Four Levels of Hospice Care
Not all hospice care is the same; there are various levels to meet the needs of different people.
There are four levels of Medicare-certified hospice care:
- Routine Home Care
- Respite Care
- General Inpatient Care
- Continuous Care
1. Routine Home Care
Also called:
- Routine hospice care
Routine hospice care is received wherever the patient calls home, from the patient’s own home to an assisted living community. The goal is management of the patient’s symptoms by a well-rounded hospice team, which can include social workers, nurses, chaplains, and more.
2. Respite Care
Also called:
- Short-term assisted living
Respite care is short-term care for routine home care hospice patients whose primary caregiver—usually a family member—needs a break from caregiving duties. It is typically provided in an assisted living community.
3. General Inpatient Care
Also called:
- GIP
- Inpatient hospice care
When medical supplies or specific hospice services cannot be rendered at home, someone can enter general inpatient care. It provides 24-hour skilled nursing care in an inpatient setting, such as a hospital, a freestanding hospice facility, or a skilled nursing facility. The primary goal is to control severe pain and stabilize symptoms so that the patient can return home, if possible.
4. Continuous Care
Also called:
- Crisis care
- Continuous home care
Continuous care is for patients experiencing a medical crisis or when they are in need of 24/7 nursing care services. A licensed hospice care team is necessary for this level, and it is often received in the patient’s home.
A hospice nurse is typically in the home for at least eight hours in a 24-hour period to manage symptoms like severe pain, uncontrolled nausea, or respiratory distress. The goal is to stabilize the patient so they can return to routine home care.
Hospice Care Qualifications
To qualify for hospice care, a person typically needs to meet specific medical criteria, primarily related to their prognosis. The general qualifications include:
- Terminal illness: The individual must have a terminal illness.
- Life expectancy: A physician (or two physicians, depending on the payer) must certify that the individual has a life expectancy of six months or less if the illness runs its normal course. This prognosis is a medical estimate and can be re-certified if the patient lives longer.
- Focus on comfort, not cures: The individual must agree to accept palliative care (comfort care) for the terminal illness rather than curative treatment. This does not mean discontinuing all medical care, but rather shifting the focus to managing symptoms and improving quality of life.
- Physician certification: A doctor must write a referral or order for hospice care.
Paying for Hospice Care
Families can pay for hospice care in a variety of ways. Most costs associated with hospice are covered by the following:
- Medicare
- Medicaid
- Private insurance
- VA benefits
- Self pay
- Charity care
About Palliative Care
Palliative care is a level of care that focuses on symptom management, especially pain management, and quality of life improvement rather than curing the condition ailing the patient. In addition to symptom management, many Medicare-certified hospice providers also provide emotional support and even spiritual support from chaplains.
Core Components of Palliative Care
Key aspects of palliative care include the following.
Focus on Quality of Life
The primary goal is to provide comfort and improve the overall well-being of the patient and their family, regardless of the stage of illness.
Symptom Management
Palliative care provides relief from pain and other distressing symptoms that may arise from the illness itself or its treatments. This can involve a variety of pharmaceutical and non-pharmaceutical therapies.
Interdisciplinary Team Approach
Care is provided by a team of healthcare professionals, including doctors, nurses, social workers, chaplains, and other specialists. This team works in coordination with the patient’s primary care team.
Provided Alongside Curative Treatment
Unlike hospice care, palliative care can be offered at any stage of a serious illness, starting from diagnosis. A person does not have to give up treatments to cure their health condition to receive this type of care.
Holistic Support
It addresses a wide range of needs beyond just physical symptoms, including emotional, psychological, spiritual, social, and practical concerns.
Advance Care Planning
Care teams can assist patients and families in discussions about their goals and wishes for care, which can inform the development of advance directives like living wills.
Settings of Care
Care is offered in various settings, including a patient’s home, hospitals, nursing homes, or outpatient clinics.
Difference from Hospice Care
While hospice care is a specialized type of palliative care, the key distinction is that hospice care is typically for patients with a terminal illness who have a life expectancy of six months or less, and who have decided to forgo curative treatment.
Palliative care, on the other hand, can be initiated at any point in a serious illness, even at diagnosis, and can continue for months or even years, alongside ongoing curative treatments.
Paying for Palliative Care
Palliative care costs can be covered by:
- Medicare
- Medicaid
- Private insurance
- VA benefits
- Private pay and other resources, like retirement funds, savings accounts, and health savings accounts (HSAs)
About Home Health Care
Home health care refers to a wide range of medical services provided in a patient’s home for an illness or injury. It is a type of skilled care delivered by licensed healthcare professionals, such as nurses and therapists, under specific orders from a physician.
The primary goal is to help patients recover, regain independence, and become as self-sufficient as possible, often as an alternative to hospitalization or skilled nursing facility care.
Core Components of Home Health Care
Key characteristics and services of home health care include:
Medical in Nature
Home health care focuses on clinical or skilled medical needs.
Physician’s Order Required
These services require a doctor’s order and are typically provided by a Medicare-certified home health agency.
Skilled Services
It includes services like skilled nursing care (e.g., wound care, injections, medication administration, monitoring serious illnesses, patient and caregiver education), as well as physical, occupational, and speech-language therapy.
Intermittent and Part Time
Home health care is usually provided on an intermittent or periodic basis, rather than 24-hour continuous care.
Homebound Eligibility
For Medicare coverage, patients typically need to be “homebound,” meaning they have difficulty leaving their home without help or leaving is not recommended due to their condition. However, being homebound is not the same as being bedbound, and services are designed to help patients move around better.
Patient and Caregiver Education
Home health staff teach patients and their informal caregivers how to manage ongoing care, including medication, wound care, and stress management.
Coordination of Care
Home health staff work closely with the patient’s physician to create and update a customized plan of care.
Additional Support
While the primary focus is skilled medical care, home health care can also include assistance with daily living activities (such as bathing, dressing, and mobility) from a home health aide, but typically only if the patient is also receiving skilled nursing or therapy services. Medical social services may also be provided.
In short, home health care aims to provide necessary medical attention in a comfortable and familiar environment, promoting recovery, and preventing or postponing the need for institutionalization.
Paying for Home Health Care
Payment for home health care services can come from a wide variety of sources, including:
- Medicare
- Medicaid
- Private health insurance
- Long-term care insurance
- VA benefits
- Private pay
- Public programs/community organizations
FAQs
What does stage 4 hospice mean?
Stage 4 hospice often refers to the highest level of hospice care. Most put crisis care at the highest level.
What is the most common level of hospice care?
Routine home care is the most common level of hospice care.
What does hospice not tell you?
There are many misconceptions about hospice care, and hospice providers won’t always tell you the following:
- Anyone can receive hospice care, not just the elderly or those with a terminal illness.
- Hospice offers more than pain management. Other services include companionship, emotional support, and spiritual support.
- There is no timeframe for hospice care. Some patients receive this care for years. While Medicare and other insurance policies may require someone to have a life expectancy shorter than 6 months, not all insurance policies have this requirement, and coverage may extend if someone lives past this initial diagnosis.
How do I choose a hospice provider?
When searching for hospice providers, make sure that you get the following information:
- Fully transparent pricing. What’s covered by your insurance? Is there a deductible? Are certain services standard or add-on?
- What hours will the team be on board? Are they only available at certain times?
- Medical equipment. Does your preferred provider have the necessary tools to deliver care in your loved one’s home, or will your loved one need to visit a facility to receive care?
What is palliative care?
Also called:
- Comfort care
Palliative care is care centered on alleviating symptoms like pain. Its goal is symptom management, not curing any disease or condition. It is different from curative care, which focuses on curing diseases and conditions.
Which hospice levels have Medicare coverage?
Someone may be eligible for hospice care coverage if they meet the following conditions:
- The patient has Medicare Part A, also called Hospital Insurance.
- The patient’s hospice doctor and medical doctor both agree the patient is terminally ill with a life expectancy of no more than 6 months.
- The patient accepts palliative care rather than curative care.
- The patient signs a statement saying they are opting for hospice over other Medicare-covered services
How long will Medicare pay for hospice?
If someone meets the eligibility requirements for Medicare-covered hospice care, Medicare can cover two 90-day hospice benefit periods. This period may then be “followed by an unlimited number of 60-day benefit periods.”
Can family members and caregivers be involved in hospice care at all four levels?
Yes, family and caregivers can be present for a loved one receiving hospice care at all four levels, although the exact role they play may vary. In continuous home care, for example, family may help hospice nurses with certain daily tasks. Conversely, in crisis care, family members may step back from caregiving roles and instead focus on offering emotional support.
What is home health?
Home health refers to healthcare services received in someone’s own home, wherever the patient considers their home to be: a house, memory care community, group home, or assisted living facility.
What are the four levels of hospice care?
Hospice care can suit the needs of many families; it depends on the level of care you choose to fit your family’s unique situation.
- If your loved one needs help managing symptoms for a chronic condition but can safely live at home, routine home care is ideal.
- If your loved one is experiencing a medical crisis, continuous care is worth exploring.
- If your relative’s needs cannot be met at home, short-term general inpatient care is worth considering.
- If your family needs a break from caregiving duties, short-term respite care can be the right choice.
Remember that there is no right or wrong choice. Only the right choice for your family.
Disclaimer: Each person’s situation is unique. This article is for general informational purposes only and is not intended to take the place of medical, financial, tax or legal advice.
Wendy Gores, RN