CAHPS Education: Levels of Hospice Care
Q: What are the levels of hospice care and when is each appropriate?
A: There are four levels of hospice care. Find out more about each level and when it is appropriate.
Levels of Care:
Routine Home Care (RHC): Routine Home Care is the most common level for hospice patients. Most hospice patients start on RHC and often continue at this level of care throughout their time on hospice. This level is appropriate for patients who are NOT in a “crisis period.” Crisis periods are defined as “a period in which the individual requires continuous care to achieve palliation or management of acute medical symptoms” or for those without need for caregiver respite.
Continuous Care (CC): Continuous care is provided only during brief periods of crisis to maintain the patient at home. Patients on continuous care receive primarily nursing care, though some CNA care is available as well, for 8-24 hours per day. 51% of the care must be done by a nurse. An accute medical crisis is required to initiate continuous care.
Inpatient Respite Care (Respite): Short-term inpatient care, often just referred to as respite, may be provided to the patient only when needed to provide relief to family or other caregivers. It may be provided only on an occasional basis and is reimbursed for no more than five consecutive days at a time. Only patients with a caregiver are eligible for respite.
General Inpatient Care (“Inpatient” or “GIP”): A patient receives hospice care in a hospital or other contracted facility that provides 24/7 nursing care for pain control or acute or chronic symptom management which cannot be managed in other settings.
Don’t confuse the 4 levels of care with the 4 disaster codes. Both the level and disaster code are determined at intake and updated, if need be, throughout the patient’s stay on hospice.
Disaster Code 1
Patients on Continuous Level of Care.
Patients who are actively dying and/or patients who are in an acute pain/symptom crisis and require skilled nursing intervention for symptom management.
Patients dependent on Oxygen and or other essential medical equipment requiring electricity to operate including facility patients if the facility has no back-up generator.
Disaster Code 2
Patients who live alone.
Patients without adequately trained caregivers.
Disaster Code 3
Patients residing at home with adequate trained caregivers.
Disaster Code 4
Patients residing in a Nursing Facility, (needs are met by facility/hospital).
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While these codes and levels are second nature to those of us who’ve been in the world of hospice for a while, reminding yourself, and educating newer team members will help develop a care-centered focus with a clear eye on better outcomes for patients and caregivers and will show in the responses to CAHPS surveys.
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