Understanding Hospice
Understanding the Four Levels of Hospice Care
Hospice isn't one single type of care. The level of support can change as a patient's needs change.
Many families are surprised to learn that Medicare recognizes four distinct levels of hospice care.
A person may spend most of their time receiving hospice care where they live and temporarily need a higher level of support if symptoms become difficult to manage or a caregiver needs a short period of relief.
Understanding these four levels can help families know what support is available — and why hospice care can adjust as circumstances change.
The Four Levels
Hospice Care Changes With the Patient's Needs
Hospice is built around an individualized plan of care. The level of care provided can change as a patient's symptoms, condition or caregiver needs change.
Level 1
Routine Home Care
Everyday hospice support wherever the patient calls home.
The most common level of hospice care for patients whose symptoms can be managed in their current living environment.
Level 2
Continuous Home Care
Temporary, intensive support during a crisis at home.
Increased hospice nursing support provided for a brief period when a medical crisis requires intensive symptom management to help the patient remain at home.
Level 3
General Inpatient Care — GIP
Short-term inpatient care for symptoms that can't be managed in the current setting.
A higher level of hospice care for pain or other symptoms requiring intensive management in an inpatient environment.
Level 4
Inpatient Respite Care
Short-term inpatient care that gives the caregiver time to rest.
Temporary care in an approved inpatient setting when a patient's usual caregiver needs a short break from caregiving responsibilities.
Level One
Routine Home Care
Hospice where your loved one calls home.
Routine Home Care is the level of hospice care most patients receive when their symptoms are stable enough to be managed in their current living environment.
Despite the word "home," this does not necessarily mean a private house.
Hospice may be provided wherever the patient calls home, including a private residence, a family member's home, an assisted living community, a senior living setting, a nursing facility or another residential care setting.
Under Routine Home Care, the hospice interdisciplinary team follows an individualized plan designed around the patient's physical, emotional and spiritual needs. Depending on that plan, support may include nursing visits, hospice aide services, physician oversight, social work, spiritual care, medications related to the terminal illness, medical equipment, supplies and other covered hospice services.
When might Routine Home Care be appropriate?
Examples may include a patient whose:
- Pain and symptoms are reasonably controlled
- Condition does not currently require intensive crisis management
- Care needs can safely be supported in the patient's current setting
- Hospice plan of care can be carried out through scheduled visits and support
Does "Routine Home Care" Mean a Nurse Is at the Bedside 24/7?
No.
Routine hospice includes scheduled visits based on the patient's plan of care rather than continuous bedside nursing. Stonewood families also have access to 24/7 on-call nursing support when questions or changes arise.
Level Two
Continuous Home Care
Extra nursing support during a brief crisis at home.
Continuous Home Care is a higher level of hospice support used during a brief period of medical crisis when a patient requires significantly more nursing care to manage symptoms while remaining in their home setting.
This level is not the same as having a permanent 24-hour private-duty caregiver.
Under Medicare guidelines, Continuous Home Care consists predominantly of nursing care provided during a qualifying period of crisis. Hospice aide or homemaker services may also supplement that nursing care.
Possible situations may involve rapidly changing or difficult-to-control symptoms that require frequent assessment, medication adjustments or intensive nursing intervention.
The Goal
The goal of Continuous Home Care is to provide the increased clinical support necessary to manage the crisis while allowing the patient to remain at home when that can be done safely and appropriately.
Important
Continuous Home Care is intended for brief periods of crisis, not ongoing around-the-clock custodial or companion care. The hospice clinical team determines whether a patient's situation meets the requirements for this level of care.
Level Three
General Inpatient Care (GIP)
When symptoms require more intensive management than can be provided in the current setting.
General Inpatient Care — often called GIP — is a short-term inpatient level of hospice care for patients experiencing pain or other acute or chronic symptoms that cannot feasibly be managed in their current setting.
A GIP stay may be appropriate when the patient needs intensive symptom management, frequent clinical assessment, medication adjustments, observation or other interventions that cannot safely or effectively be provided elsewhere.
Possible reasons for GIP may include difficult-to-manage symptoms such as:
- Uncontrolled pain
- Severe shortness of breath or respiratory distress
- Persistent nausea or vomiting
- Severe agitation or restlessness
- Symptoms requiring frequent medication adjustment
- Other complex symptoms requiring intensive hospice management
GIP Is Intended to Be Short-Term
General Inpatient Care is not intended to become permanent residential placement. The goal is to stabilize and manage the symptoms that required inpatient care. When symptoms can again be safely managed at a lower level of hospice care, the patient may transition back to the appropriate setting and level of care.
Inpatient Hospice in Southeast Texas
Stonewood Inpatient Hospice Unit
Stonewood operates a dedicated General Inpatient Hospice Unit in Port Arthur for eligible patients who need a higher level of comfort-focused symptom management.
The unit is located inside The Medical Center of Southeast Texas, 3rd Floor – South Wing, while being independently operated and clinically staffed by Stonewood Hospice.
The Stonewood Inpatient Hospice Unit welcomes eligible patients throughout Southeast Texas, including patients currently served by other hospice providers.
Level Four
Inpatient Respite Care
Caring for the caregiver matters, too.
Family caregivers give an extraordinary amount of themselves when caring for someone with a serious illness.
Hospice recognizes that caregivers sometimes need time to rest, attend to their own health, handle personal responsibilities or simply recharge.
Inpatient Respite Care provides short-term care for an eligible hospice patient in an approved inpatient setting so the patient's usual caregiver can temporarily step away from day-to-day caregiving responsibilities.
Under the Medicare hospice benefit, inpatient respite care may generally be provided for up to five consecutive days at a time when the applicable requirements are met.
Respite Care Is Different From GIP
General Inpatient Care
Primary reason
The patient needs intensive pain or symptom management that cannot be provided in the current setting.
Inpatient Respite Care
Primary reason
The caregiver needs temporary relief from caregiving responsibilities.
Both are inpatient levels of hospice care, but they serve very different purposes.
A Common Point of Confusion
Level of Care and Place of Care Are Not the Same Thing
Families often hear terms such as "home hospice," "inpatient hospice," "nursing home hospice" or "residential hospice" and understandably assume these are different levels of hospice.
But where someone lives and the Medicare level of hospice care they are receiving are not necessarily the same thing.
A person living in an assisted living or nursing facility may be receiving Routine Home Care because that facility is where the person calls home.
A patient living in a private residence may temporarily receive Continuous Home Care during a qualifying medical crisis.
A patient whose symptoms cannot be effectively managed in their current setting may temporarily receive General Inpatient Care in an appropriate inpatient facility.
The patient's hospice team evaluates what level of care is appropriate based on the patient's condition and circumstances.
The Right Care at the Right Time
Can a Patient Move Between Hospice Levels?
Yes.
Hospice care is designed to respond as a patient's needs change.
A person may receive Routine Home Care for an extended period, temporarily need Continuous Home Care or General Inpatient Care during a crisis, and later return to Routine Home Care after symptoms are stabilized.
A caregiver may also need occasional respite support.
Moving from one hospice level to another does not necessarily mean the patient is "getting worse" or that something has gone wrong. It means the hospice plan is being adjusted to provide the level of support appropriate to the situation.
Home
Care
How Do We Know Which Level of Hospice Care Is Needed?
Families don't need to diagnose the situation or determine a level of care themselves.
The hospice clinical team evaluates the patient's symptoms, care needs, living situation, caregiver support and individualized plan of care.
If you're already receiving hospice and something changes, call your hospice team.
If you're not yet receiving hospice and are wondering whether someone you love may qualify, Stonewood can help you understand the next step.
The Four Levels of Hospice Care at a Glance
Purpose
Ongoing hospice support when symptoms can be managed in the patient's current setting
Where
Wherever the patient calls home
Duration
Based on ongoing hospice eligibility and patient needs
Purpose
Intensive nursing support during a brief medical crisis
Where
Patient's home setting, not an inpatient facility
Duration
Temporary, during a qualifying period of crisis
Purpose
Intensive pain and symptom management that cannot feasibly be provided elsewhere
Where
Appropriate inpatient setting
Duration
Short-term, until the symptoms requiring GIP are controlled
Purpose
Temporary relief for the patient's caregiver
Where
Approved inpatient setting
Duration
Generally up to five consecutive days at a time under the Medicare hospice benefit
Frequently Asked Questions About the Four Levels of Hospice Care
Continue Learning About Hospice
← Back to Hospice Resources & Family GuidesWho Qualifies for Hospice? →
Learn about the medical criteria and eligibility requirements for hospice care.
When Is It Time for Hospice? →
Recognize the signs that a loved one may benefit from hospice support.
What Does Hospice Cost? →
Learn what Medicare, Medicaid and private insurance may cover for hospice care.
Stonewood Inpatient Hospice Unit →
Short-term inpatient hospice care for patients with uncontrolled symptoms.
Free Download
Is It Time for Hospice? A Family Guide & Checklist
A practical guide to help families recognize when hospice may be appropriate.
We're Here to Help
Not Sure What Kind of Hospice Support Your Family Needs?
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Tell us what's happening. Stonewood's team can listen, answer your questions and help you understand what type of support may be appropriate for your loved one.
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Sources
- • Centers for Medicare & Medicaid Services — Medicare Hospice Benefit and Hospice Levels of Care
- • Medicare.gov — Hospice Care and Levels of Care
Written by: Stonewood Hospice
Last reviewed: August 2026
This information is provided for general education and does not determine an individual's eligibility for hospice or a specific level of care. Hospice eligibility and level-of-care decisions are based on each patient's medical condition, needs and individualized plan of care.