Does hospice provide 24 hour care? Changes in Levels of Care


Understanding the different levels of care, and how they are utilized in hospice, can provide some reassurance that your loved one’s needs will be met.

Providing care to your loved one during this sacred time is a genuine expression of your love for them.  With the responsibilities may also come some challenges, like  juggling new medications, foreign tasks, along with having to provide personal care.  This is all compounded by the emotional toll of grieving an anticipated loss.  It is natural to be fearful about what to expect, or how you will feel. Hospice will walk with you, and there are several layers of support available, that will act as our safety net.

A commonly asked question is… Will hospice provide a nurse to care for my loved one 24 hours a day?

The answer is not a particularly simple one.  When someone is started on hospice care in their home, it is always important to identify who will be the patient’s primary caregiver.  If someone
does not have a person to provide hands on care, then their home may not be a very practical setting to provide hospice services.  We teach families to how to provide the care necessary to keep their loved ones safe and comfortable.  If it is becoming increasing difficult to physically manage the tasks related to providing personal care, there may be some options for you to get some more assistance.  The social worker will work will assist you in finding some solutions.  Unfortunately, hospice does not provide 24 hour caregivers for the purpose of providing personal care.  There are times though, when it might be appropriate to provide an increased level of care for a patient.  Hospice agencies are required by Medicare to be able to provide that assistance.

Routine Level of Care

Hospice care is usually provided at a routine level of care in all types of living situations.  We provide care in  private homes, assisted living facilities, personal care homes, and long term care nursing homes.  The nurse case manager will typically have a planned visit, with the patient, 1-2 times a week. Medicare strictly requires that a patient must assessed by a nurse at least every 14 days.  It is not uncommon for a hospice nurse to conduct a daily visit, if it is in the best interest of the patient.

A hospice aide can be a great help to the situation. Their visits last about an hour, and they will typically come up to 5 times a week, depending on the need.  The hospice aide is a Certified Nursing Assistant (CNA), and they play a vital role in the delivery of hospice care.  Their primary focus is on hygiene and safety, while providing assistance with bathing, feeding, and personal care.  The relationship that develops between a patient and their hospice aide is unique, and these caregivers provide a lot of emotional support to their patients and loved ones.

Respite Level of Care

Caring for a loved one who is suffering from a serious disease or illness can be stressful at times.  Hospice understands the demands that are being placed on you, and we want to support everyone involved.  Respite care is intended for the purpose to reduce caregiver strain or burnout, and to allow the person who is providing the care have a rest period. The social worker is an excellent resource, if you are considering using the respite care part of your hospice benefit.  Patients will typically go to a nursing home setting, and may stay for up to five consecutive days. Hospice will ensure that have a contract with the nursing facility that you choose.  Your hospice doctor continues to oversee the care provided, while the hospice providers will make daily visits to the facility.  If the patient is able to get into the car, it is always nice for the family to drive the patient to the nursing home.  If you are not able to get your loved one into a care, hospice is ultimately responsible for the transport of the patient.  They are required to make special accommodations, like arranging for an ambulance.

Continuous Care (CC)

It does not matter whether the patient lives in a private residence or a nursing home, hospice must provide this level of care, if the patient meets the criteria.  Continuous Care is when hospice arranges to have a licensed staff member at the patient’s bedside, continually, 24 hours a day.

 This level of care is reserved for patients that are suffering from severely uncontrolled symptoms of pain, shortness of breath, persistent vomiting, active bleeding, or restlessness with agitation.  The goal of continuous care is for hospice to step in and stabilize a crisis situation, in an effort to get unpleasant symptoms under control. This level of care is intended to be short term, and requires a lot of documentation to justify it to Medicare.   Typically a nurse must be able to document frequent medication administration and interventions, and monitor the response for effectiveness.  Many hospice agencies will contract with another nursing agency to provide staffing for this level of care, and most likely it will be a nurse providing all of the care.  Although,  Medicare only requires that 50% of care be provided by a nurse, and the remaining hours can be supplemented with a CNA.   Please note: CNAs may not legally administer medications.  I have personally never seen continuous care coordinated with a CNA, but I could imagine it might have some challenges.

 The truth is…  in hospice care, the event of a real true crisis is rare.  With the right guidance from your hospice team, your loved one can be very comfortable and peaceful.

General Inpatient (GIP)

Hospice care that is provided in hospitals, hospice units, and other types of facilities at the highest level is referred to as General Inpatient.  Very seldom do patients go from a home setting to an inpatient setting, because continuous care is a more practical approach.  When someone is admitted to hospice at this level of care, it is because they are very ill.  These patients are usually imminent, meaning they are medically unstable, and will likely pass away in the next few days.  This level of care usually does not extend beyond a week.  If a hospice patient is in a general inpatient setting, and their condition improves, the patient will generally be transferred to a lower level of care.  Arrangements will have to be made to move the patient to an alternative setting like a nursing home or a private residence.

One of the core principles of hospice care is that everyone has the right to die with dignity and free from pain.   Your hospice team will guide you, to ensure that your loved one’s needs will be met.

I hope that you found this article helpful.  Please feel free to ask a question or leave a comment.




8 Comments

  • Jackie May 24, 2017 at 5:26 pm

    Thank you for explaining the levels of care in hospice which I didn’t know or understand. Hospice is such a great service not only for the patient but for their families. My best friend’s mom just had continuous care as she was getting ready to transition and it was so comforting to have them to help the family. Thank you for doing this work that is so needed.

    Reply
    • Heather Williams RN CHPN May 25, 2017 at 5:42 am

      Thank you. Continuous Care is a tremendous relief under stressful conditions.
      All the Best,
      Heather

      Reply
  • Uta May 24, 2017 at 9:06 pm

    Hi
    Thank you for this honest and clear article.
    I start to work in a spiritual care center soon and so I am browsing for more informations and perspectives.

    I like the focus in your writing and I totally agree. Everyone has the right to die in peace and with dignity.

    There is a book related. Maybe you know about it.

    The Tibetan Book of Living and Dying
    Sogyal Rinpoche

    Blessings
    Uta

    Reply
    • Heather Williams RN CHPN May 25, 2017 at 5:45 am

      I have not heard of that book, but it does sound interesting, I will take a look. Thank you for taking the time to visit my site .
      Take Care,
      Heather

      Reply
  • verna8767 May 25, 2017 at 3:29 pm

    Hi Heather,
    This is a terrific article. I have been the go-to caregiver for several of my family members who have been in hospice care, both at home and inpatient.

    It is indeed a tremendous undertaking and the caretaker must be a strong person both physically and emotionally.
    Many people feel that they want their loved ones to be at home during their last days or the patient themselves desire that. However, family members need to understand how difficult it can be and know that there are other options for hospice care than trying to do it all themselves.

    The information you provided was right on point and I’m glad you wrote this article because it will be very valuable to people who don’t know what choices they have when loved ones come to the end of life’s journey here on earth.

    Keep doing good for others. Thank you.

    Verna

    Reply
  • Heather Williams RN CHPN May 25, 2017 at 3:51 pm

    I really appreciate your feedback, I am very pleased that you found this information valuable.
    Thank you!
    Heather

    Reply
  • roland deleoin May 27, 2017 at 12:54 am

    I have come to appreciate your articles and the clarity that comes from them. I am a hospice chaplain and I am very blessed to do what I do. Loving people at this time in their life has saved my life and working with wonderful nurses, social workers and CNA’s has blessed my life more than I could ever express. Thank you for your time to write, explain and share your experience.

    Reply
  • Heather Williams RN CHPN May 28, 2017 at 1:38 pm

    Thank you for the nice words and the valuable service you provide as a chaplain.
    Take Care,
    Heather

    Reply

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