For patients & families · Understanding the benefit

The four levels of hospice care.

Medicare gives every hospice patient access to four different levels of care. You start at the routine level — that is where most days are spent. The other three are tools we use when something changes. Knowing what each one is, and when it applies, makes hard moments less confusing.

1Routine

Routine home care

Day-to-day, the most common level

This is hospice as you imagine it. The patient is at home — their actual home, an assisted-living apartment, or a long-term-care room. Visits from nurses, aides, social workers, chaplains, and volunteers happen on a regular schedule. The 24-hour phone line is always there. Roughly 95% of all hospice days, nationwide, are routine days.

Where
Patient's place of residence
Visits
Per the plan of care, typically 5–8 per week
2Continuous

Continuous home care

Brief crisis with an unmanaged symptom

If a symptom flares to a crisis — uncontrolled pain, severe shortness of breath, agitation that won't settle — and we believe we can resolve it at home, we send a nurse for an extended stretch (eight or more hours in a 24-hour period, more than half spent on nursing care). The goal is to manage the crisis at home so a hospital trip isn't needed.

Where
Patient's home
Duration
Hours, sometimes a day or two
3Inpatient

General inpatient (GIP)

Symptoms that cannot be managed at home

For symptoms that genuinely cannot be controlled in the home setting — complex medication titration, agitation requiring close monitoring, end-stage symptoms in the final days — we move the patient to a contracted inpatient unit at a partner facility. Care is delivered around the clock by hospital staff coordinating with our team. When the symptom resolves, the patient returns home.

Where
Contracted hospital, hospice IPU, or SNF
Duration
Until the symptom is controlled
4Respite

Inpatient respite

A planned break for the family caregiver

If you are the primary caregiver, you can — and should — take a break. Inpatient respite covers up to five consecutive days of care for the patient at a contracted facility, so you can rest, travel for a wedding or funeral, attend to your own medical appointments, or simply sleep through the night. Respite can be used as often as needed; we encourage families to use it before they are exhausted, not after.

Where
Contracted SNF or hospice IPU
Duration
Up to 5 consecutive days, repeatable

·How a change in level happens

Levels of care are decided by the hospice team based on what is needed clinically — not by you, and not by Medicare directly. If your loved one's symptoms change, the nurse and physician will decide together whether a higher level is needed and explain it to you in plain language.

You can always ask. If you think a higher level is needed, call. If you think your loved one is ready to come home from inpatient, call. Levels can shift up and down as often as the situation requires.

The cost to you, in nearly every case, is zero. Medicare's hospice benefit covers all four levels in full when used appropriately. Some plans charge a small copay for inpatient respite (typically 5% of the room-and-board rate). We will tell you in advance if anything is expected.

Routine days at home are always free under the Medicare hospice benefit.

When to ask about a level change

Trust your instinct.

If you feel like things are getting away from you — at any hour — call. Most calls don't lead to a level change; they lead to a same-day visit, an adjusted dose, a better plan. But sometimes a level change is exactly what's needed, and we'd rather you ask than tough it out alone.

"You are not bothering us. This is what the phone line is for."