Medicare defines four official levels of hospice care: Routine Home Care, Continuous Home Care, Inpatient Respite Care, and General Inpatient Care. Each level is designed for a specific clinical situation, and a patient can move between them as their condition changes.
Most patients spend the majority of their time on Routine Home Care, but knowing that the other three levels exist and when to ask for them can make a meaningful difference in how comfortable and supported your loved one is throughout the hospice journey.
How the Four Levels Are Structured
The four levels of hospice care are defined by the Centers for Medicare and Medicaid Services (CMS) and are part of the standard Medicare Hospice Benefit. Every Medicare-certified hospice is required to offer all four levels. The level of care a patient receives at any given time is determined by their clinical needs and is documented in the hospice plan of care.
Patients are not locked into a level. Movement between levels is common and does not require re-enrollment or a new evaluation. The hospice team monitors the patient regularly and adjusts the level of care as the situation changes.
You can also find a summary of the four levels here: AlēvCare 4 Levels of Care
Level 1: Routine Home Care
The most common level and the foundation of the hospice experience.
Routine Home Care is the level most patients are on for the majority of their time in hospice. It is what most families picture when they think about hospice: a team of professionals who visit the patient regularly at home, manage symptoms, provide support, and remain available when questions arise.
What It Includes
Under Routine Home Care, the patient receives scheduled visits from their Registered Nurse Case Manager, who assesses their condition, manages pain and symptoms, educates the family on medications and the disease process, and adjusts the care plan as needed. Visit frequency is based on the patient’s individual needs and can increase as the illness progresses.
The care team during Routine Home Care also includes:
- Certified Nursing Aides
- A Licensed Social Worker
- A Chaplain
- Volunteers
A nurse is available 24 hours a day, seven days a week for phone consultation or urgent visits, even during Routine Home Care.
When It Applies
Routine Home Care is appropriate when the patient’s symptoms are manageable and stable enough to be addressed through scheduled visits. It is the default level for patients who are at home or in an assisted living community and are not experiencing an acute crisis.
Most patients begin their hospice journey at the Routine Home Care level and may remain there throughout.
Level 2: Continuous Home Care
Intensive, around-the-clock support at home during a medical crisis.
Continuous Home Care, sometimes called crisis care, is one of the most important and least understood levels of hospice. It exists specifically to keep patients at home during a period of acute medical crisis, rather than sending them to the emergency room or hospital.
What It Includes
During Continuous Home Care, a hospice nurse or trained aide is present in the home for a minimum of eight hours in 24 hours, with nursing providing the majority of that care. This level is designed for short-term, intensive symptom management and is maintained only as long as the crisis requires it.
The Registered Nurse plays a central role during this level, managing acute symptoms in real time, administering and adjusting medications, and keeping the family informed throughout. The AlēvCare Medical Director is closely involved in guiding the clinical plan during these periods.
When It Applies
Continuous Home Care is appropriate when a patient experiences an acute medical crisis that requires intensive intervention to manage, but where that intervention can reasonably be provided at home.
This level is a safeguard. Families should know it exists and should not hesitate to call the hospice team immediately when symptoms escalate; that is exactly what the 24/7 nursing line is for.
Once the crisis is stabilized, the patient typically returns to Routine Home Care.
Level 3: Inpatient Respite Care
Short-term inpatient support designed to give family caregivers a temporary break.
Respite Care is the level of hospice care that exists not for a clinical crisis, but for caregiver relief. It acknowledges something that is often overlooked in serious illness: the people doing the caregiving are carrying an enormous weight, and they cannot sustain that indefinitely without rest.
What It Includes
Under Inpatient Respite Care, the patient is temporarily admitted to a Medicare-approved inpatient facility, such as a hospice inpatient unit, a hospital, or a skilled nursing facility, for a short stay. During that time, the patient’s care is managed by the inpatient facility’s team, and the primary family caregiver has a genuine opportunity to rest, recover, and tend to their own needs.
When It Applies
Inpatient Respite Care is appropriate when the primary caregiver needs temporary relief, not because the patient’s symptoms have escalated, but because the caregiver has reached a point where they cannot continue without a break.
Learn more about how AlēvCare approaches caregiver support by visiting the Respite Care page
Level 4: General Inpatient Care
Inpatient care for symptoms that cannot be managed at home.
General Inpatient Care is the highest level of hospice care and is reserved for situations where a patient’s symptoms are severe enough that they cannot be managed safely or effectively in a home setting, even with Continuous Home Care.
What It Includes
During General Inpatient Care, the patient is admitted to a Medicare-approved inpatient facility where they receive intensive, around-the-clock clinical management from a skilled team.
The AlēvCare Medical Director coordinates with the inpatient facility’s team to ensure the patient’s goals and comfort preferences are honored, even in an inpatient setting.
When It Applies
General Inpatient Care is appropriate when symptoms become too complex or severe to manage at home, even with intensive hospice support. Common situations include:
- Pain that cannot be controlled with oral medications and requires IV administration or rapid titration
- Severe respiratory distress requiring close clinical monitoring
- Acute neurological symptoms such as uncontrolled seizures
- Profound agitation or delirium that is unsafe to manage in a home environment
- Complex wound care or medical needs beyond what can be addressed in the home
As with all levels of hospice care, General Inpatient Care is temporary when clinically possible. Once symptoms are stabilized, patients often return home to Routine Home Care.
Hospice Care in North Texas
AlēvCare Hospice serves families across North Texas, including Tarrant, Johnson, Hood, Parker, Dallas, and Ellis counties, providing all four levels of Medicare-defined hospice care. Care is delivered at home, in assisted living communities, and in other home-like settings, with close coordination with local physicians and facilities to keep care connected and consistent.
To confirm coverage in your area, visit: Service Area.
The Level of Care Your Loved One Needs Is the One They Are Getting Right Now
If you have questions about where your loved one is in that continuum, or if you are wondering whether a higher level of care might be appropriate for what they are experiencing, the AlēvCare team is ready to listen. Call (469) 630-2538 to speak with our team, or schedule a free in-home consultation and let us come to you.
Hospice is not a one-size answer to a complex situation. It is a flexible, Medicare-defined continuum of support that adjusts to meet your loved one wherever they are on their most stable days and their most difficult ones.
