What Are the Four Levels of Hospice Care? A Complete Guide
When facing a terminal illness, ensuring compassionate, tailored, and timely support is critical for patients and their loved ones. Many families and caregivers ask, “What are the four levels of hospice care?“ Understanding these levels is crucial to accessing the right services and ensuring patients live their final days with dignity, comfort, and peace.
Hospice care focuses on relieving pain, managing symptoms, and providing emotional and spiritual support rather than curative treatments. It’s not just a place—hospice is a philosophy of care that can be delivered in homes, inpatient centers, or hospitals. The four distinct levels of hospice care—routine home care, continuous home care, general inpatient care, and respite care—are structured to address varying degrees of patient needs and provide flexibility in care delivery.
Understanding the Four Levels of Hospice Care
Hospice care in the United States is structured into four levels, defined and regulated by the Centers for Medicare & Medicaid Services (CMS). These levels were designed to provide scalable support, depending on a patient’s medical and psychosocial needs. They also allow hospice providers to bill appropriately and ensure families receive care that aligns with their current situation.
The four levels are:
- Routine Home Care
- Continuous Home Care
- General Inpatient Care
- Respite Care
Each of these levels is tailored to meet patients where they are—whether at home, in a hospital, or in a hospice facility—and adjust as their conditions evolve.
Let’s explore each level in detail.
Routine Home Care: What to Expect
Routine home care is the most common and foundational level of hospice care. It is provided in the patient’s residence—whether that be their home, an assisted living facility, or a nursing home.
Key Features:
- Scheduled visits from hospice nurses, home health aides, social workers, and chaplains.
- Medication and pain management oversight.
- Medical equipment and supplies provided as needed (e.g., hospital beds, oxygen).
- Emotional, psychological, and spiritual support tailored to the patient and their family.
- 24/7 on-call availability for emergencies.
Who Qualifies?
Patients qualify for routine home care if they:
- Have a life expectancy of six months or less (if the illness follows its natural course).
- Choose comfort-focused care over curative treatment.
- Do not require continuous nursing services.
Routine home care allows patients to stay in a familiar and comforting environment, surrounded by loved ones. The hospice team acts as a coordinated support system to manage symptoms and provide holistic care.
How It Helps:
- Reduces hospital visits and emergency room usage.
- Supports families with grief counseling and caregiver training.
- Promotes dignity, autonomy, and comfort during end-of-life care.
Continuous Home Care: When Extra Support is Needed
Continuous home care (CHC) is designed for patients experiencing acute symptoms that require more intensive medical intervention. This level provides short-term, round-the-clock care in the patient’s home to manage crises without the need for hospitalization.
Key Features:
- Nursing services for at least 8 hours in a 24-hour period (often more).
- Skilled symptom management (e.g., pain, agitation, severe nausea, seizures).
- Assistance with crisis stabilization while remaining in the home environment.
- A higher level of observation and adjustment to care plans in real-time.
Who Qualifies?
Patients qualify for continuous home care when they:
- Are experiencing a medical crisis that can be managed at home.
- Need short-term, intensive nursing care but prefer to avoid inpatient settings.
- Show signs of severe physical or psychological distress that cannot wait for routine care adjustments.
This level of care is often used to stabilize conditions like uncontrolled pain, respiratory distress, or anxiety and agitation that arise unexpectedly or worsen quickly.
How It Helps:
- Maintains patient comfort and dignity without unnecessary hospital transfers.
- Prevents disruption to the patient’s environment, offering peace of mind.
- Supports families who may feel overwhelmed during medical emergencies.
General Inpatient Hospice Care: Managing Acute Symptoms
General inpatient care (GIP) is the most intensive level of hospice care, offered in a hospital, hospice facility, or contracted nursing home setting. It is used when a patient’s symptoms are too complex to manage at home, even with continuous care.
Key Features:
- 24/7 medical supervision by hospice physicians and nurses.
- Access to IV medications, complex pain regimens, and other advanced medical treatments.
- Physical, emotional, and spiritual support during critical periods.
- Social work services for crisis intervention and emotional processing.
Who Qualifies?
Patients qualify for GIP when they:
- Have unrelieved, severe pain or symptoms requiring aggressive symptom management.
- Cannot remain safely at home despite high-level care.
- Are in need of short-term stabilization with the goal of returning to home care once symptoms are controlled.
Examples of qualifying situations include:
- Uncontrolled bleeding.
- Intractable pain that oral medications cannot relieve.
- Severe respiratory distress or panic attacks.
How It Helps:
- Provides immediate relief for distressing symptoms.
- Gives families peace of mind knowing their loved one is in a safe, professional environment.
- Helps transition patients back to home-based hospice care once stability is achieved.
Respite Care: Relief for Family Caregivers
Respite care is a short-term inpatient service designed to provide temporary relief to family caregivers. Caregiving is an emotionally and physically demanding role, and respite care ensures caregivers can rest and recharge without compromising the quality of care their loved one receives.
Key Features:
- Up to five consecutive days of inpatient care in a Medicare-approved facility.
- 24/7 supervision of the patient by skilled hospice staff.
- All care needs, including medications, meals, and activities, handled by the facility.
- Continued emotional and spiritual support for the patient.
Who Qualifies?
Respite care is appropriate when:
- A caregiver needs a break due to exhaustion, illness, travel, or other personal obligations.
- The patient’s condition is stable but still requires professional oversight.
- The caregiving arrangement is temporarily unavailable (e.g., family out of town).
This benefit is available under Medicare and most insurance plans, typically for up to five days at a time, and can be used intermittently.
How It Helps:
- Prevents caregiver burnout and promotes long-term sustainability.
- Encourages self-care and well-being among family caregivers.
- Provides patients with a safe, comfortable setting without compromising continuity of care.
Choosing the Right Level of Hospice Care
The transition between levels of hospice care isn’t rigid. Patients may move from routine home care to continuous care if a crisis arises, or to general inpatient care if symptoms escalate. Once stabilized, they can return home. This flexibility allows hospice providers to meet patients’ evolving needs with compassion and precision.
The hospice team—which includes physicians, nurses, social workers, chaplains, home health aides, and volunteers—works together to regularly reassess the care plan. Communication with the patient and family is at the core of this approach.
By understanding the four levels of hospice care, families can make informed decisions and feel empowered knowing that help is available at every stage.
A Personalized Hospice Experience with Grace and Glory Hospice
At Grace and Glory Hospice, we believe that end-of-life care should be as unique as the life lived. Serving patients across California, including Brentwood and surrounding areas, our team is dedicated to offering personalized hospice care services that uphold dignity, comfort, and peace.
Whether your loved one is best supported at home or needs inpatient care, we provide expert guidance and compassionate service across all four levels of hospice care. From managing pain to supporting family caregivers, we are here to ensure no one walks this journey alone.
If you or a family member are considering hospice, we invite you to reach out for a consultation. Let us walk alongside you, offering strength, expertise, and heartfelt support.
Contact us today to learn more about our compassionate, patient-centered hospice services.