Medicare defines four distinct levels of hospice care: Routine Home Care, Continuous Home Care, General Inpatient Care, and Respite Care. Each level is designed to match the intensity of care to what a patient actually needs at a given moment. 

Most patients receive care at the routine level, but the other three levels exist so that support can scale up quickly when symptoms change or caregivers need a break. Understanding all four helps families know what is available and feel confident that care will not fall short. 

This guide walks through each level clearly, in the order you are most likely to encounter them.

How Medicare Structures Hospice Care

The Medicare Hospice Benefit, administered through the Centers for Medicare and Medicaid Services (CMS), covers hospice care for eligible patients who have a terminal diagnosis with a life expectancy of six months or less if the illness follows its expected course, and who choose to focus on comfort rather than curative treatment.  This does not mean that the patient cannot live longer than six months and in fact, many patients do.  In that case they are recertified for hospice if they still meet the criteria.  Some patients, because of the phenomenal care that Hospice gives, become better and are able to graduate off hospice.

Within that benefit, Medicare establishes four levels of care. These levels are not a ranking of severity or a one-way progression. A patient can move between them more than once based on what their condition requires. The hospice team is responsible for assessing needs regularly and recommending the appropriate level at each stage.

Level 1: Routine Home Care

What it is: Routine Home Care is the foundation of the hospice benefit and the level most patients experience for the majority of their time on hospice. It is provided wherever the patient calls home, whether that is a private residence, an assisted living facility, or a nursing home.

What it includes:

• Scheduled visits from registered nurses to manage pain and symptoms
• Personal care assistance from certified nursing aides for bathing, grooming, and comfort
• Social work support for practical planning and family communication
• Spiritual care for patients and families
• Medications, equipment, and supplies related to the hospice diagnosis
• 24-hour on-call nurse access for questions or concerns between visits

What it looks like day to day: A nurse may visit two to three times per week, but the frequency depends on the patient’s status. An aide may come several times a week to help with personal care. The social worker and chaplain check in regularly. Between visits, a nurse is always available by phone.

The care plan is built around the patient’s specific needs and adjusted over time. Families are not left to manage symptoms alone.

Our registered nurses and certified nursing aides play a central role at this level, providing consistent, hands-on support with clinical oversight from our hospice medical director.

Level 2: Continuous Home Care

What it is: Continuous Home Care, sometimes called Crisis Care, is a temporary, intensive level of support provided in the home during a medical crisis. It is available when symptoms become severe enough that routine visits are no longer sufficient but the patient does not need to leave their home.

When it applies: This level is appropriate when a patient is experiencing:

• Uncontrolled pain that requires extended nursing intervention
• Acute breathing difficulty or severe respiratory distress
• Intense anxiety or agitation that cannot be managed with scheduled visits
• Other acute symptoms that require close, continuous monitoring

What it covers: During Continuous Home Care, a nurse or hospice aide is present in the home for an extended period, typically at least eight hours in a 24-hour period, to provide direct support and symptom management. The goal is to stabilize the patient as quickly as possible and return to Routine Home Care once the crisis resolves.

What families should know: This level is one of the most important and least understood parts of the hospice benefit. It means that when something serious happens at home, the answer does not have to be a call to 911. The hospice team can often come to the patient and manage the situation in familiar surroundings, which is almost always where patients want to be.

Level 3: General Inpatient Care

What it is: General Inpatient Care (GIP) is provided in a Medicare-approved inpatient facility, such as a freestanding inpatient hospice facility, a hospital with a hospice unit, or in some cases a skilled nursing facility. It is intended for patients whose symptoms cannot be managed at home even with Continuous Home Care.

When it applies: General Inpatient Care is appropriate when:

• Pain or symptoms require clinical interventions that cannot be safely performed at home
• A patient needs around-the-clock monitoring by skilled nursing staff
• A short-term inpatient stay is needed to stabilize the patient before returning home

What it is not: General Inpatient Care is not permanent placement. It is not a transfer out of hospice or a signal that home care has failed. It is a temporary escalation of care, and in most cases the goal is to get symptoms under control so the patient can return to their preferred setting.

The hospice team continues to manage the patient’s care during a GIP stay. Families should expect the same care team to remain involved and to communicate clearly about the plan and what comes next.

Level 4: Respite Care

• What it is: Respite Care is the one level of hospice care designed primarily for the caregiver rather than the patient. It provides a short-term break by temporarily placing the patient in an inpatient facility, usually for up to five consecutive days, while the primary caregiver rests.
• Why it matters: Caregiving during a serious illness is physically and emotionally demanding. A caregiver who is exhausted, burned out, or unwell cannot provide the consistent support their loved one needs. Respite care is not a luxury. It is a recognized part of the Medicare Hospice Benefit because CMS understands that the wellbeing of the caregiver is directly connected to the quality of care the patient receives.
• What it covers: During Respite Care, the patient receives appropriate nursing and comfort care in an inpatient setting. When the respite period ends, the patient returns home and Routine Home Care resumes.
• Who can use it: Any hospice caregiver can request Respite Care. If you are feeling stretched or need time to manage your own health and responsibilities, talk to your hospice team. You do not need to be in crisis to ask for this support.

Learn more: The Four Levels of Hospice Care

How Care Moves Between Levels

Levels of care are not a ladder that patients climb in sequence. A patient may spend weeks at the routine level, shift to continuous care for a few days during a symptom crisis, return to routine care, and later use respite care so their family can regroup. The movement between levels is driven entirely by what the patient needs and what the family can sustain.

Your hospice team reassesses the patient’s condition regularly and will communicate clearly when a change in level is recommended. You always have the right to ask questions, understand the reasoning, and be part of that decision.

For a broader picture of what the hospice journey looks like from beginning to end, review The Admission Process if you are in the early stages of exploring care.

What Stays Consistent Across All Four Levels

Regardless of which level a patient is at, certain things do not change at Foundations Hospice.

The same interdisciplinary team remains involved. The same care philosophy guides every decision. The same 24-hour on-call support is available. Spiritual care and bereavement support continue throughout the hospice journey regardless of setting or level.

Comfort, dignity, and the patient’s personal wishes remain the organizing principle at every level. A change in care level is a change in the type of support being delivered. It is not a change in commitment.

Ready to Talk Through Your Options?

Understanding the levels of care is one part of feeling prepared. Having a team you trust to navigate them with you is the other. Call (225) 209-5629 to speak with a member of our care team, or request a complimentary hospice resource guide to have on hand as you prepare. There is no obligation, and no pressure. Just clear answers when you need them.

Foundations Hospice serves families across Southeast Louisiana, including Livingston, St. Tammany, East and West Baton Rouge, Ascension, Jefferson, Orleans, and surrounding parishes. We provide care wherever your loved one is most comfortable and are available 24 hours a day, seven days a week.