Hospice is care, not a place. It’s specialized support for people living with a serious illness and for the people who love them. Wherever you and your loved one call home, hospice meets you there.

Hospice care adjusts as your loved one’s needs change. To make that possible, Medicare and most insurance plans recognize four levels of hospice care. These aren’t four separate programs; they’re one continuum of care that can shift with your loved one throughout their illness.
The level of care your loved one receives depends on what they need at any given moment. Your hospice team will work closely with you to recommend the right level and help you understand what to expect.

The Four Levels of Hospice Care at a Glance

Routine Home Care

This is the most common level of hospice care. Routine home care is provided wherever your loved one lives—whether that’s a private home, an assisted living facility, or a skilled nursing facility.

This level is right when your loved one’s symptoms are stable and well-managed with their current medications and treatments. Hospice becomes part of the care your loved one is already receiving, supporting family caregivers, privately hired aides, or the team at their skilled nursing or assisted living facility. You can expect regular visits from members of your hospice interdisciplinary team, which may include:

• A hospice physician, who oversees the medical plan
• A registered nurse (RN) case manager, who coordinates day-to-day care
• A home health aide, who helps with bathing, grooming, and personal care
• A social worker, for emotional support and help navigating practical matters
• A spiritual care provider, available no matter what your beliefs or traditions are
• A trained volunteer, for companionship and caregiver respite
• A creative arts therapist and bereavement support, depending on what your family needs
• Your RN case manager will visit regularly to check on your loved one’s comfort, adjust the care plan, and make sure you have everything you need to care for them at home.

Continuous Home Care

Continuous home care is a more intensive level of care provided during a symptom crisis. It’s used when your loved one experiences severe pain, shortness of breath, or another distressing symptom that can’t be managed through routine visits alone. During continuous home care, a hospice nurse or health care professional stays in the home to provide close, steady monitoring—at least 8 hours within a 24-hour period—until symptoms are under control. This level is always time-limited and ends as soon as the crisis has passed and your loved one can return to routine home care.

General Inpatient Care

General inpatient care is the highest level of hospice care. It’s provided when your loved one’s symptoms are severe enough that they need around-the-clock medical attention that can’t be given at home. This level of care typically takes place in a hospice inpatient unit, a skilled nursing facility, or a hospital contracted with your hospice provider. The focus is on advanced pain and symptom management until your loved one is stable again.
Once symptoms are well-controlled, most patients return home and resume routine home care.

Respite Care

Respite care gives family caregivers a chance to rest. Caring for someone you love is meaningful, but it can also be exhausting. Respite care lets you step back to travel, recover from an illness, or simply catch your breath—while your loved one receives skilled hospice care in a safe setting. Respite care is provided in a contracted skilled nursing facility or other inpatient setting for up to five days at a time, once per benefit period. After respite ends, your loved one returns home and resumes their usual level of care. You don’t need to be in crisis to use respite care. Your hospice team can help you plan ahead so you can take a break before you’re running on empty.

How the Levels Work Together

Most people move between levels of care during their hospice journey. A patient might begin with routine home care, briefly shift to continuous home care during a rough night, move to general inpatient care for a few days to get symptoms under control, then return home.
Your hospice team reassesses your loved one’s needs continuously and will recommend changes to the level of care when it would better support comfort and quality of life. You and your family are always part of that conversation.

Support for Caregivers, Too

No matter which level of care your loved one is receiving, hospice supports you as well. Social workers, spiritual care providers, volunteers, and bereavement counselors are part of every hospice team and are available to help you carry what you’re carrying.

If you have questions about which level of care is right for your loved one or how hospice care can shift as their needs change, your hospice team is the best place to start.