Levels of Care
The are four different levels of hospice care: routine care, inpatient care, continuous care and respite care. Each type of hospice care is design to meet the needs of the hospice patient and family. Routine Care is provided either in the home or healthcare center. Hospice care is provided by all disciplines offering specialty support and education.
Routine Hospice Care in the home: Often the patient and family want the patient to die in the home and are willing and physically able to care for the dying patient in that setting. The hospice team including the volunteer makes regular visits to the patient providing care as needed. Sometimes the patient wants to die at home, but the family, especially the caregiver, can not offer this care on an extended basis. The family may request that the patient be transferred to a healthcare facility or an inpatient unit for the final days of care.
Routine Hospice Care in the healthcare center: Healthcare centers (once called nursing homes) offer long-term care for elderly and disabled adults. The hospice team provides care to the patient in the healthcare center offering all the same services, education, and support that is offered to the hospice home patient.
Inpatient care is designed for pain control and symptom management that cannot be fully addressed in the home or healthcare environment. Often once the pain is managed and under control, the patient may return home or back to a healthcare center. Care-giver breakdown occurs when a caregiver is unable to provide care due to stress or illness. This may be another reason for an inpatient admission, providing a break for the caregiver by taking the patient from the home for a period of time allowing the caregiver to rest or to explore other care giving arrangements such as a long-term care placement.
Inpatient care is often provided in a specially designed facility for the dying hospice patient who does not want to die at home or in a healthcare facility. Peachtree Christian Hospice in Duluth (www.peachtreechristianhospice.com) is the Atlanta metro inpatient facility managed by United Hospice. In other areas of the state and in other states, United Hospice has contracts with inpatient units and local hospitals to provide this level of care for our patients.
For the dying patient who lives in a nursing home, hospice care programs can provide the following services:
- Nursing services above and beyond the usual nursing home care
- Training of family members in patient care, as appropriate
- Spiritual and emotional support for both the patient and the family
- Help with practical matters associated with terminal illness
- Speech, occupational and physical therapies (when these services are considered useful by the hospice team)
- Coordination of services and care with the patient's family doctor
- Expert management of physical symptoms
- Bereavement and support groups for families
Continuous Care is designed to provide skilled nursing care during times of crisis or for pain and symptom management. This care is provided in the home or the health care center in order to avoid hospitalization. Continuous care is provided for at least 8 hours in a 24 hour period.
Respite care is designed to offer the home care-giver a temporary relief (time out or time away) from the duties of caring for the patient. Volunteers are often the first resource for respite care; however, when 24/7 care is needed, a sitter service can be hired by the family to provide extra respite care. In addition, Medicare will pay for respite care for a period of 5 days in a health care center to allow the caregiver a break. Trained hospice volunteers can work in any of these settings of hospice care; each volunteer selects where and how they want to serve.