Routine, continuous home care, general inpatient, respite
Hospice levels of care: criteria and documentation
Medicare pays for hospice at four levels of care. Routine home care is the default. Continuous home care and general inpatient care are short-term responses to a symptom crisis and must be medically necessary. Inpatient respite gives the caregiver a break for up to 5 days at a time. The hospice interdisciplinary group decides the level each day based on the patient's needs, and the record must support it.
Reviewed by our medical director, September 24, 2026
On this page (7 sections)
The four levels at a glance
| Level | When it applies | Where | Key limits |
|---|---|---|---|
| Routine home care | Any day the patient is at home under hospice care and is not receiving continuous home care. | Wherever the patient lives: private home, RCFE, board-and-care home, nursing facility. | Paid per day. A higher rate applies to the first 60 days. A service intensity add-on can apply to nurse and social worker visits in the last 7 days of life. |
| Continuous home care | A brief period of crisis, only as necessary to maintain the patient at home. | The patient's home, including a facility that is the patient's residence, subject to the rules on facility-provided care. See the regulation. | Minimum of 8 hours of care in a 24-hour day that runs midnight to midnight. More than half of the hours must be nursing care by an RN or LPN/LVN. Aide and homemaker hours can make up the rest. Paid hourly. |
| General inpatient care (GIP) | Short-term pain control or acute or chronic symptom management that cannot feasibly be provided in other settings. | A Medicare-participating hospital, skilled nursing facility or hospice inpatient unit under contract with the hospice, or one the hospice operates. | Short-term. Necessity is reassessed daily. Counts toward the hospice's aggregate inpatient day cap. |
| Inpatient respite care | Short-term inpatient care only when necessary to relieve the family members or other persons caring for the patient at home. | A contracted Medicare or Medicaid participating hospital, nursing facility or hospice inpatient unit. | No more than 5 consecutive days at a time, on an occasional basis. Days beyond the fifth are paid at the routine rate. The patient owes 5% coinsurance under Medicare. |
When general inpatient or respite care is needed, the hospice team confirms a contracted facility with an available bed and arranges the clinical handoff and transport before any transfer.
General inpatient care: what qualifies
GIP is for a symptom the team has tried, or cannot reasonably try, to manage where the patient lives. Typical reasons are pain that needs frequent medicine adjustment and close nursing assessment, intractable nausea or vomiting, respiratory distress, uncontrolled seizures, severe agitated delirium, uncontrolled bleeding, and complex wound care that cannot be delivered at home. It is provided when medically necessary during a symptom crisis and ends when the symptom is controlled or the patient can be managed in another setting.
GIP is not for caregiver breakdown alone. That is respite. It is not custodial care, a place to wait for a nursing facility bed, or an automatic level for a patient who is imminently dying without an uncontrolled symptom. A hospital patient who elects hospice can receive GIP in the same hospital only if the hospice has a contract there and the patient has a qualifying symptom need. See the discharge planner guide.
Continuous home care: what qualifies
Continuous home care brings predominantly nursing care to the bedside for a brief period of crisis, to keep the patient at home. The same kinds of uncontrolled symptoms that would justify GIP apply. It is provided when medically necessary during a symptom crisis. It is not a standing private-duty service and is not triggered by the family's wish for more hours alone.
The 8-hour minimum is counted within one calendar day, midnight to midnight, and the hours do not have to be consecutive. If fewer than 8 hours are provided, or nursing is not more than half, the day is paid as routine home care. In a facility, care that facility staff already provide is not counted.
Inpatient respite: what qualifies
Respite depends on the caregiver's need, not on the patient's symptoms. Examples are caregiver exhaustion, caregiver illness or surgery, or a family event. It is available up to 5 days at a time and only occasionally. It does not apply to a patient who lives in a facility where staff provide the daily care. The facility must be able to provide 24-hour nursing that meets the patient's plan of care.
Documentation expectations
| Level | The record should show |
|---|---|
| Routine home care | A current plan of care, visits that match the ordered frequencies, and ongoing eligibility documentation. |
| Continuous home care | The crisis that began the period: the symptom, its severity and what had been tried. Hour-by-hour entries showing who provided care, their discipline, the interventions and the patient's response. Total hours and nursing hours for each midnight-to-midnight day. Physician orders and contacts. The reason the period ended. |
| General inpatient care | The precipitating symptom and why it could not be managed in another setting. What was tried before the transfer. Daily documentation of interventions that require the inpatient setting, such as frequent titration, parenteral medicines and frequent skilled assessment, with the response. Daily interdisciplinary review of continued need. Discharge planning from day one. |
| Inpatient respite | The caregiver's situation and why respite is necessary. Start and end dates. The plan for return home. |
Reviewers look for specifics. Vague entries such as a note that the patient is declining or is actively dying do not by themselves support a higher level of care.
How to request a change in level of care
If a hospice patient in your facility or practice has a symptom that is not controlled, call the hospice number in the patient's record. A hospice nurse answers the phone 24 hours a day, 7 days a week, and can visit when needed. The nurse assesses, contacts the hospice physician, and the team decides whether a change in medicines, more visits, continuous home care or a GIP transfer is the right response. The level of care is a hospice decision made with the patient, the family and the attending physician.
For a family-readable explanation, see levels of hospice care. For eligibility for hospice itself, see the eligibility guidelines.
Patients have the right to choose their hospice provider. Beta Hospice does not offer anything of value in exchange for referrals.
Common questions
Is there a day limit on GIP?
The regulations describe GIP as short-term and do not set a fixed number of days per stay. Medical necessity must be documented for every day, and long stays draw review. Hospices are also subject to an aggregate cap on inpatient days. See 42 CFR 418.302.
Can continuous home care be provided in a nursing facility or RCFE?
It can be provided where the patient resides, but only hospice-provided hours count, and coverage rules differ by setting. See the regulation and ask us about the specific case.
Does a patient have to change levels to get more visits?
No. Visit frequency under routine home care changes with need. Higher levels of care are for crises that visits alone cannot manage.
Who pays room and board during respite or GIP?
The inpatient rate covers the stay in the contracted facility. Under routine home care, Medicare does not pay room and board where the patient lives.
About this page
- Written by
- Beta Hospice care team
- Clinically reviewed by
- our medical director
- Last reviewed
- September 24, 2026
- Next review
- March 24, 2027
How we write and review this site
Sources
- 42 CFR 418.204: Special coverage requirements (continuous home care, respite, bereavement) (opens in a new tab)
- 42 CFR 418.302: Payment procedures for hospice care (levels of care) (opens in a new tab)
- 42 CFR 418.202: Covered services (opens in a new tab)
These sources support the general information on this page. For one person’s care and coverage, talk with the hospice team.
Refer a patient or ask a clinical question
Call any time. A nurse can talk through eligibility, timing and logistics for your patient.
Patients have the right to choose their hospice provider.