Do You Know The 4 Levels Of Care?

Do You Know The 4 Levels Of Care?
By Victor Montour

Most people are unaware there are four levels of care provided by all hospices in the United States. Every patient receiving hospice services in the United States will be on one of these four levels. A hospice patient can move from one level of care to another level of care and back, depending on the services required to fulfill his or her needs. The clinical needs of the patient will be used to determine if the patient meets the appropriate criteria for a higher level of care.

Routine Home Care – Patient at home with symptoms controlled

Routine level of care is the level of care most patients will be placed in at the time of admission. This level of care can be provided to patients while they reside at home (or a long-term care facility) and does not have symptoms which are out of control. These symptoms could include—but aren’t limited to—severe pain, continuous nausea and vomiting, bleeding, acute respiratory distress, and unbearable restlessness or agitation. A patient at this level may have access to the following services:

• Registered Nurse Visits
• Social Worker Visits
• Chaplain Visits
• Home Health Aide Services
• Counselors
• Medications
• Equipment

The needs of the patient determine the number of visits from hospice staff members. These needs are established and outlined in a plan of care formed by the patient or Medical Power of Attorney, the hospice team and the patient’s physician. The care plan serves as a guideline to assist all those serving the patient with care. At this level of care the patient also has access to an on-call hospice nurse twenty-four hours a day seven days a week.

Respite Care – Patient at facility with symptoms controlled

A patient may be moved to respite care when the caregiver needs a break. Many hospice patients live at home, with their family providing most of the care, sometimes around the clock. Caring for their loved one can be exhausting and very stressful. The family members and/or caregivers need time to themselves and it’s important that they take that time. Respite care allows a patient to be temporarily placed in a facility with 24-hour care so the family can rest. If the patient is willing and the family requests it, hospice must provide placement in a facility or a hospice home for the patient. The patient will be transferred to the facility, and according to Medicare regulations, can stay for up to five days before being transferred back home. A patient at this level may have access to the following services:

• Registered Nurse Visits
• Social Worker Visits
• Chaplain Visits
• Home Health Aide Services
• Counselors
• Medications
• Equipment

Continuous Nursing Care – Patient at home with uncontrolled symptoms

A patient would receive continuous nursing care if he or she has symptoms that are out of control and choose to stay at home. This is similar to inpatient care, except that the patient remains in his or her home instead of being placed in a facility. A hospice nurse is required to provide continuous around-the-clock nursing care if the symptoms cannot be controlled while on routine home care. Hospices are required to provide this level of care if it is needed. This level of care requires certain criteria be met to be placed under this level of care. This level of care is a short lived benefit. Patients in this level of care must have their symptoms under control within 72 hours. Once symptoms are under control the patient must be moved back to the routine level of care. A patient at this level may have access to the following services:

• Registered Nurse Visits
• Social Worker Visits
• Chaplain Visits
• Home Health Aide Services
• Counselors
• Medications
• Equipment

Inpatient Care – Patient at home or in a facility with uncontrolled symptoms

A hospice patient may require inpatient care when his or her symptoms have gotten out of hand and can no longer be managed at home. When these symptoms cannot be controlled on routine home care, then the patient requires extra attention until these symptoms subside. Hospices take aggressive actions to control the symptoms and make the patient comfortable. In order to do this, the patient may be temporarily placed in a hospice home, skilled nursing facility or an acute care hospital. At this level of care, a moment-to-moment assessment of what’s happening and what needs to be done takes place. The hospice team and the patient’s physician work together to ensure the patient obtain and maintain a tolerable comfort level. Once this has been achieved, the patient will return home and back to routine home care. Again certain criteria must be met to be placed in this level of care. The only physician who can determine a patient meets criteria is the hospice physician or hospice medical director. This level of care is a short lived benefit. Patients in this level of care must have their symptoms under control within 72 hours. A patient at this level may have access to the following services:

• Registered Nurse Visits
• Social Worker Visits
• Chaplain Visits
• Home Health Aide Services
• Counselors
• Medications
• Equipment

If you would like more information about Front Range Hospice or the 4 levels of care call 303-957-3101 or 970-776-8080 or email us at info@frhospice.com

Watch out for our next blog: Taking Responsibility for Reductions in Hospital Readmissions: Be Careful