***This posting is a follow-up to my August 3rd post in The 50 Plus Male, “Refining The Physically Fit Male—Surviving The Urban

written by Staci Warsaw

Let’s talk about a thing called “levels of care”. The hospice benefit has four of them.

I will start by saying that each of these levels of care is guided by the same principle; pain and symptom management. That is the ultimate goal of the hospice program; to ensure people die with dignity and comfortable. Each level is managed in some way, shape or form by the hospice team; with the hospice nurse being in the middle and ensuring the needs of the patient and their family members are met. The hospice team consists of the nurse, physician, social worker, chaplain, home health aide and volunteers.

Routine care: This is the most common level of care utilized by patients. It consists of intermittent visits by the hospice team provided wherever a person lives. This level of care is for a patient who is in the terminal phase of their illness, but whose symptoms are well managed. It is the level used the vast majority of the time. The patient must have a primary caregiver or caregivers available to help meet his or her needs at any time. Patients are seen a few times a week on average, by the hospice team. This is modified as the patients needs change, and according to patient and family wishes.

Inpatient care: This level of care is available for the patient in crisis with exacerbation of pain or symptoms related to their terminal illness. Pain, bleeding, respiratory and cardiac events are some examples of when inpatient care is needed. This level of care must take place in a facility that has Registered Nurses 24/7. That means a hospital and many nursing homes. This level of care is usually short-term; lasting a few days to a week. Once the crisis is resolved, the patient returns to their home.

Continuous Care: The requirements to receive continuous care are exactly the same as those for inpatient care. The patient must be in crisis, with unmanaged symptoms or pain. The difference is the hospice staff increases their in-home care to 24 hours a day until the crisis has past. If a patient needs continuous care, a certain percentage of the care MUST be given by a nurse. This level is also usually very short-term; lasting a day or two at most the vast majority of the time.

Respite Care: This is the level of care that is used to manage caregiver breakdown. Any of you who have cared for a loved one through illness know that it is taxing on mind and body. Caregivers sometimes need a break. So, the hospice team will arrange for the patient to go to a facility for a maximum of 5 days so their caregiver can refresh and rejuvenate. The facility must have a nurse available for any medical needs that may arise. The stay is paid for by hospice, so there is no financial burden for the caregiver.

Tags: continuous care, hospice benefit, hospice team, intermittent visits, social worker