Hospice                                                         
   
FAQ  
Levels of Care  
Circle of Care  
  

Criteria for Hospice Inpatient Care and Continuous Care

Eligibility for Inpatient or Continuous Care includes symptoms that require acute medical management. Examples include, but are not limited to, the following:

• Uncontrolled pain

  • Sudden onset or severe uncontrolled pain
  • Ongoing pain control/management requiring frequent adjustment in dose or analgesia requiring constant monitoring and evaluation
• Intractable nausea and vomiting

• Respiratory distress

Symptoms of severe shortness of breath

• Abrupt changes in psychosocial problems and uncontrolled symptoms which can create significant stress on the patient/family

• Abrupt change in behavioral or cognitive abnormalities causing severe agitation, disorientation, or combative behavior

  • Severe emotional stress in the patient and/or caregiver
  • Suicide ideation, gestures, or attempts
  • Acute breakdown in family dynamics, such that they can no longer care for the patient
  • Death is imminent with unstable symptoms and caregiver stress
• Intractable Seizures requiring intensive intervention, continuous monitoring, and medications

• Hemorrhage causing symptoms which are difficult for the family to manage

• Other symptoms defined by the interdisciplinary team as unmanageable by the family

Level of Care
Routine Home Care
Respite Care
Inpatient Care
Continuous Care
Routine For the family Higher level of care Higher level of care
Goal This is routine care provided to the patient wherever the patient is living, whether that is in the home, Assisted Living Facility or Nursing Home. 96% of hospice care is provided at this level. Respite is provided when the family or caregiver of the patient needs some time away from the intensity of caregiving. Respite is provided in contracted beds at local nursing homes or hospitals. Inpatient Care is provided at a hospice inpatient unit, local hospital, or contract Nursing Home that has registered nurses on site 24 hours a day. Continuous Care is provided to patients during a crisis period as necessary to maintain the patient in the home. Nurses and Certified Nurse Assistants monitor acute symptoms that require more intensive and continuous nursing care than is generally provided under routine home care.
Location of Patient Any patient eligible for hospice is eligible for this level of care. Any hospice patient is eligible for respite. Patients who are in the last stages of living (“actively dying”) or who have uncontrolled symptoms that cannot be managed in the home, Assisted Living Facility, or Nursing Home are eligible for Inpatient Care. Uncontrolled symptoms such as severe, uncontrolled pain, unrelenting nausea and vomiting, “terminal restlessness /agitation,” bleeding, and acute respiratory distress are some of the types of symptoms that warrant Continuous Care.
Contract RHC contract required in nursing facility Respite Care contract required Inpatient contract required RHC contract required
Time Frame As long as the patient is deemed appropriate for hospice services and meets the Medicare criteria for hospice care. Respite Care is limited to a maximum of 5 consecutive days at any one time. Inpatient Care for the “actively dying” ends at the end of the patient's life. For those with uncontrolled symptoms, Inpatient Care is provided until symptoms are resolved. Medicare guidelines generally limit Inpatient Care to a 14-day stay. Medicare and Medicaid require that Continuous Care be provided in “brief periods.” Many private insurers limit this type of care more specifically to 3 days.
RN Facility N/A Facility must have 24-hour RN coverage on site. Facility must have 24-hour RN coverage on site. N/A
Meds, Equipment Supplies Hospice provides all medications, equipment and supplies related to the terminal diagnosis. Hospice provides all meds, equipment and supplies related to the terminal diagnosis. (Patient/Family may be able to bring any non-covered meds to the facility.) All meds, equipment and supplies are included in contracted rate paid to facility. All meds, equipment and supplies, as previously covered, related to the terminal diagnosis.
Staff Visits Visit frequency is established by the individualized plan of care and patient needs. Nursing Staff is available 24/7 through our on-call services. Visit frequency is the same as for routine home care. Nursing Staff is available 24/7 through our on-call services. Inpatient Care for the “actively dying” ends at the end of the patient's life. For those with uncontrolled symptoms, Inpatient Care is provided until symptoms are resolved. Medicare guidelines generally limit Inpatient Care to a 14-day stay. Either a Nurse or Certified Nurse Assistant will be present in the home a minimum of 8 hours out of every 24 hours of continuous care. The total number of hours spent is dictated by the patient’s condition.
Facility Reimbursement Hospice does not pay Room and Board. Room and Board must be funded by MCD or Private Pay. Hospice and nursing facility cannot both bill Medicare Part A for a patient who is in a “Skilled” Bed for same diagnosis. Hospice bills Medicaid (if applicable) and then gives Medicaid payment to nursing facility for Room and Board ( state specific). Respite Care is covered at the contracted rate for up to 5 days by hospice – additional days are arranged by facility/family. Hospice pays facility at a negotiated contracted rate. No change in Room & Board reimbursement to facility.
Hospice Reimbursement Medicare Part A prospectively pays hospice as a daily rate inclusive of all ordered treatments and care. A nursing facility and hospice cannot both bill Part A for the same diagnosis. Hospice is reimbursed a daily rate, which in turn is given to the facility for care provided. Hospice does not get reimbursed for both Respite Care and RHC. Medicare prospectively pays hospice at a higher daily rate inclusive of all ordered treatments and care. Medicare reimburses hospice at an hourly rate.
Order Needed YES YES YES YES
Change in Facility and Hospice Care Plan Needed YES YES YES YES
 

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