Inpatient hospice care, explained for families

What is inpatient hospice care?

General inpatient care is one of the four levels of hospice care. It is for a symptom crisis: pain or other symptoms that need a level of care that cannot be given in any other setting. Medicare defines a general inpatient day as a day of care in an inpatient facility for pain control or symptom management that cannot be managed in other settings (42 CFR 418.302).

The stay is for comfort, not to treat the illness. The hospice team stays in charge, the facility follows the hospice plan of care, and the person keeps the same hospice.

When is general inpatient care used?

Only when pain or other symptoms, such as breathlessness, vomiting or severe agitation, need an intensity of care that cannot be given where the person lives. Medicare's manual gives these examples:

• A need to adjust medicines
• Observation, or other treatment to stabilize the person, such as closely watching how the person is coping
• A brief stay at the end of a hospital stay, when a person who has just chosen hospice still needs pain or symptom control that cannot be given elsewhere while getting ready for hospice at home

Where does inpatient hospice care happen?

Under the federal rules, general inpatient care is given in a Medicare-certified hospital, in a skilled nursing facility that meets the hospice rules for 24-hour nursing, or in a hospice's own inpatient unit (42 CFR 418.108). When a person is receiving this level of care, each shift must include a registered nurse who gives direct patient care (42 CFR 418.110).

Beta Hospice does not operate a hospice house or an inpatient unit of its own. When general inpatient care is needed, we arrange it at a hospital or a skilled nursing facility that has a contract with us. Which one depends on the person: their symptoms, what care they need, and where they live. Before any transfer for general inpatient or respite care, the team confirms a contracted facility with an open bed, shares the person's clinical details with its staff and arranges transport.

How long does inpatient hospice care last?

There is no set number of days. It lasts until the symptoms are under control. Then the person goes back to where they live on routine home care. For a person who lives at home rather than in a facility, if the usual caregiver has fallen ill, a few days of respite care can follow before the person goes home.

Some people are very close to the end of life when they are admitted and die during the stay. The team will tell you honestly what they see. A Medicare rule limits how many inpatient days a hospice can provide across all its patients, but it does not limit the inpatient days one person can receive when they are medically necessary. See the 80/20 rule.

Who pays for inpatient hospice care?

The stay is part of the hospice benefit. Medicare pays the hospice a daily rate for general inpatient care, and the hospice pays the facility under its contract. The cost-sharing Medicare lists for hospice is a copay of up to $5 per prescription for symptom medicines and 5% of the Medicare amount for inpatient respite care. There is none for general inpatient care.

If the move needs an ambulance and the hospice puts it in the plan of care, the ambulance is part of hospice care too. For a Medicare Advantage member, Original Medicare pays the hospice. Medi-Cal plans cover the same level. In California, general inpatient care is the only hospice level that a Medi-Cal managed care plan makes subject to prior authorization, and the hospice sends the request (DHCS All Plan Letter 25-008). See paying for care.

What families do during an inpatient stay

1. Step 1

   Call the hospice first

   When symptoms are out of control, call the hospice nurse line before 911. A hospice nurse answers the phone 24 hours a day, 7 days a week, and can visit when needed. See can you call 911 on hospice?.

2. Step 2

   Let the team decide the setting

   The nurse assesses, and the hospice doctor decides whether general inpatient care is needed. Ask what they saw and what the plan is.

3. Step 3

   Bring what matters

   Glasses, hearing aids, a favorite blanket, photos, music, and the list of medicines. Ask about visiting hours and whether someone can stay overnight.

4. Step 4

   Stay in touch with the hospice team

   The hospice stays in charge of the care during the stay. Ask who from the team will check in, tell them what the person would want, and ask about the plan for going home.

Is there a hospice house near me?

A hospice house is an inpatient unit that a hospice runs itself, often in a home-like building. Some hospices have one. A hospice without a house still provides inpatient care when it is needed, by contract with hospitals and nursing facilities. Beta Hospice does not run a hospice house. We serve San Bernardino, Riverside, Los Angeles, Orange and Ventura counties, and we arrange general inpatient care at contracted hospitals and skilled nursing facilities.

Medicare pays for an inpatient stay only at the general inpatient or respite level, when the person needs it. If a hospice house offers a longer stay at other times, ask what it charges for room and board, because Medicare does not pay room and board where you live.

What to ask any hospice about inpatient care

• Where would my family member go for general inpatient care: your own unit, a hospital or a nursing facility?
• How do you decide that inpatient care is needed, and who makes the decision at night or on a weekend?
• How quickly can you arrange a bed and transport?
• Who from your team will check on my family member during the stay, and how will you update us?
• Can family stay overnight?
• If symptoms settle, what is the plan for going home?

Common questions about inpatient hospice care

Related guides

The four levels of hospice care, continuous home care, where care happens, hospice in a nursing home, and, for clinicians, levels of care criteria.