Hospice care can be provided wherever a patient lives, including a private home, an assisted living community, or a nursing home, and it can also shift temporarily to a hospital or skilled nursing facility if symptoms need more intensive management. The right setting depends on the patient’s medical needs, the caregiver’s capacity, and what will bring the most comfort and stability during this time. 

Most hospice care is delivered at home under Medicare’s Routine Home Care benefit, with facility-based care reserved for short-term symptom crises or caregiver respite.

Hospice Is a Service, Not a Place

One of the most common misunderstandings is that hospice refers to a building. In reality, hospice is a philosophy of care and a coordinated team of professionals, delivered wherever a patient calls home. That could be a private residence, an assisted living community, or a nursing home. Our team provides care in each of these settings, adjusting the plan as needs change. You can see how this works: Care Services.

Medicare organizes hospice into four levels of care, and the setting can shift temporarily depending on which level a patient needs at a given time. Our 4 Levels of Care page explains each one in detail, but here’s a brief overview.

The Four Levels of Hospice Care, and Where Each Happens

• Routine Home Care is the most common level, accounting for the vast majority of hospice days nationally. The patient’s symptoms are generally well managed, and the hospice team visits on a scheduled basis wherever the patient lives.
• Continuous Home Care provides more intensive nursing support at home during a short-term medical crisis, such as a period of severe pain or breathing distress, so the patient can remain at home rather than being admitted elsewhere.
• General Inpatient Care (GIP) is short-term care in a hospital, skilled nursing facility, or dedicated hospice inpatient unit, used when symptoms become too complex to manage at home. Once symptoms stabilize, the patient typically returns to routine home care.
• Respite Care allows a patient to stay briefly at an approved facility so the primary caregiver can rest, travel, or attend to their own needs, typically for up to five days.

The ability to move between these levels, rather than being locked into one setting, is part of what makes hospice care flexible around a family’s real-life circumstances.

Learn more about the 4 Levels of Care.

What Home-Based Hospice Care Offers

For many families, staying home is the priority, and there are practical reasons this option works well for a large share of hospice patients:

• Familiar surroundings. Patients often feel calmer and more at ease in their own space, with their own bed, belongings, and routines.
• Personalized attention. Care plans are built around the patient’s specific needs and can be adjusted quickly as the situation changes.
• Family involvement. Loved ones can stay closely involved in day-to-day care, with the hospice team supporting rather than replacing that role.
• Coordination across settings. If your loved one already lives in an assisted living community or nursing home, hospice services can be layered on top of that existing living situation. Learn more about the counties we serve on our Service Areas page.

Home-based hospice does rely on a caregiver, usually a family member, being available to help with daily needs between scheduled visits. If that’s a concern for your family, our Bereavement Care and Social Workers team members can help you think through what additional support might look like.

When Facility-Based Care Makes Sense

Facility-based hospice care, whether through General Inpatient Care or a stay in an existing nursing home or assisted living community, may be the better fit when:

• Symptoms such as uncontrolled pain, agitation, or respiratory distress require intensive, around-the-clock clinical management that isn’t achievable at home.
• The patient already resides in a nursing home or assisted living facility, and hospice services are being added to that existing care setting.
• The primary caregiver needs a short-term break through respite care, whether due to their own health, exhaustion, or a family obligation.
• The home environment can’t reasonably support necessary medical equipment or safety needs, such as space for a hospital bed or wheelchair accessibility.

None of these situations reflect a “failure” to manage care at home. They reflect hospice doing what it’s designed to do: matching the level and setting of care to what the patient actually needs at that moment.

How to Think Through the Decision

There’s no single right setting for every family. A few questions can help clarify what matters most for you:

1. How stable are the patient’s symptoms right now? Well-controlled symptoms often support staying at home; complex or unpredictable symptoms may call for closer monitoring.
2. Who is available to provide day-to-day care? Consider your own capacity, other family members, and whether additional in-home support would help.
3. What does the patient want? Many patients have strong feelings about wanting to remain at home, and those wishes matter in this decision.
4. What does the home environment allow for? Physical space, accessibility, and safety all factor into whether home-based care is realistic.

You don’t have to answer these questions alone. Our What to Expect page walks through what the first weeks of hospice typically look like, and our FAQs page addresses many of the specific questions families ask during this decision.

Get Guidance Suited to Your Family’s Situation

Whether your loved one is at home, in an assisted living community, or in a nursing home, our team can help you understand what hospice care would look like in that setting and whether it’s the right time to start.

Call (225) 209-5629, available 24/7, or schedule a care consult to talk through your options. You can also review our Eligibility Guidelines or Compare Care Options page for more context.