Patients and their families who are faced with choosing hospice are often unaware of the different types of care hospice offers. Knowing the difference is important because not all patients qualify for all types of care. In this blog post, I explain the four different types of hospice care—routine care, continuous care, respite care, and inpatient care—and who can benefit from them.
Routine Care: Routine hospice care is the foundation of hospice services and is primarily provided in the patient's home, be it a private residence, assisted living facility, or nursing home. The care team, consisting of hospice nurses, certified nursing aides, physicians, social workers, and therapists, collaborates with primary caregivers to manage symptoms, provide comfort, and offer emotional support. This level of care includes assistance with daily activities, medication management, and therapies such as physical and speech therapy. Bereavement counseling is also available for families for up to a year after the patient's passing. This model of care is best for those who have primary caretakers, like family and friends, in the home. Routine care for home hospice services does not provide nursing or CNA care around the clock, and depending on caregiver capacity and knowledge, as well as the disease type, patients may need to hire additional in-home care.
Continuous Care: Continuous care is provided during times of crisis when a patient experiences severe symptoms that cannot be managed by their primary caregivers alone. It involves hospice nurses providing care for a minimum of 8 hours a day, up to 24 hours a day, to stabilize the patient and avoid hospitalization. This intensive support typically lasts for a few days until the symptoms are under control, after which the patient returns to routine hospice care.
Respite Care: Respite care offers temporary relief to primary caregivers who may experience physical, emotional, and mental exhaustion from the demands of caring for a terminally ill loved one at home. During respite care, which lasts up to 5 days, the patient stays in an inpatient facility where hospice professionals provide round-the-clock care. This allows caregivers to rest, attend to personal matters, or simply rejuvenate, knowing their loved one is well cared for.
Inpatient Hospice Care: Inpatient hospice care is the highest level of care provided when a patient's symptoms can no longer be managed at home. This could be due to severe pain, uncontrolled symptoms, or the need for complex medical interventions that cannot be safely administered in a home setting. Inpatient facilities, which can be standalone hospices or units within hospitals, offer 24/7 medical supervision in a comforting, home-like environment. The care team includes physicians, nurses, nursing aides, and other specialists who ensure the patient's comfort and dignity.
It is extremely important to note that not every hospice patient qualifies for inpatient care. To qualify, a patient must have symptoms that require intensive medical intervention and monitoring. Common criteria include uncontrollable pain, severe respiratory distress, excessive seizures, or complex wound care needing frequent attention. At the hospice where I volunteer, patients must need intravenous medication as one of the qualifications. The decision is made collaboratively by the patient's primary physician and the interdisciplinary hospice team based on the patient's unique needs.
Another thing to consider is that Inpatient care is designed to be temporary, aiming to stabilize the patient's condition so they can return home or transition to another level of hospice care, such as continuous care or routine care. Once the symptoms are managed and the patient's condition stabilizes, they may be discharged from the inpatient facility. However, I have found that most patients I visit in inpatient care are there until they pass away. This is something you can discuss with your medical care team.
Now that you understand the differences, you can make more informed decisions and better align with you and your loved one's wishes and needs at the end of life. If you have more questions or want recommendations for local hospices and at-home care providers, feel free to contact us at PeacefulCrossingsDurham@gmail.com.
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