As might be expected, 82.7 percent of hospice patients are over the age of 65. It is more surprising that one-third of these have passed their 85th birthday. The use of Medicare benefits to cover the cost of hospice care has increased correspondingly. Federal statistics show that Medicare spending for hospice care has doubled since 2000. The four levels of Hospice Care defined by Medicare are:

  1. Routine Home Care
  2. Continuous Home Care
  3. General Inpatient Care
  4. Respite Care

Routine Home Care

This consists of physician participation as needed; two or three visits a week by both a nurse and a home health aide; and the services of a physical therapist, occupational therapist, medical social worker, pastoral counselor and/or dietary counselor as needed.

Medicare covers medications and any required medical equipment/supplies used in routine home care. Depending on the physical capabilities of the caretaker, a home care aide may also be available to do such chores as shop for groceries, pick up prescriptions and monitor their use, prepare meals, clean the house, do laundry and help the patient with bathing, grooming and dressing.

Continuous Home Care

This includes all the services and care described above in routine home care, but with continuous home care a nurse or home health aide remains in the home between eight and 24 hours every day to administer medications and provide treatments and support.

This level of care is sustained as long as the patient has symptoms like unrelenting pain, severe nausea/vomiting or anxiety/panic attacks. Continuous care may also be necessary if there is a breakdown in the caregiver support system.

General Inpatient Care

Inpatient care is put in place when symptoms become too severe for home care. The patient is moved to a freestanding hospice facility, hospital or nursing home but can be returned to the home if conditions improve.

Respite Care

Respite care involves temporarily moving the patient from the home to a nursing home or inpatient facility in order to give the caregiver some much needed time off. Respite care is limited to five consecutive days at any one time.

Patients can be transferred between the four levels of care as determined by the hospice doctor and nurse.

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