You’ve enrolled in hospice, and care is going well. But you’re worried about what happens when things change. Some days require routine visits, other days demand intensive nursing. Hospice adapts, and support adjusts to match what your loved one needs at any given moment.
James River Home Health & Hospice seamlessly transitions between levels so your loved one always receives the right support at the right time.
Let’s walk through each level so you know exactly what support is available when circumstances change.
The Four Medicare-Recognized Levels of Hospice Care
Medicare defines four levels of hospice care to ensure patients receive appropriate support regardless of symptom severity or family circumstances:
1. Routine Home Care – Regular hospice visits at home (most common)
2. Continuous Care – Intensive short-term nursing at home during crisis
3. Inpatient Respite Care – Temporary facility care to give caregivers rest
4. General Inpatient Care – Hospital-level symptom management
You don’t choose the level. We adjust it based on clinical need. Our team evaluates symptoms, family capacity, and safety considerations to determine which level is appropriate, and we transition seamlessly as needs change.
All four levels are covered by Medicare, Medicaid, and most private insurance with little to no additional cost.
Level 1: Routine Home Care
What It Is: Routine Home Care is the foundation of hospice and the level most patients receive most of the time. Your loved one remains at home (or in their assisted living, memory care, or skilled nursing residence) and receives scheduled visits from the hospice team.
Who Provides Care:
- Registered Nurse (RN) – Visits 1-3 times per week (or more as needed) to assess symptoms, manage medications, provide wound care, and coordinate with the physician.
- Certified Nursing Assistant (CNA) – Provides personal care 2-7 times per week, based on the needs of the patient and the patient plan of care, including bathing, dressing, grooming, and mobility assistance.
- Social Worker – Visits as needed to provide counseling, help with advance directives, connect families with community resources, and offer emotional support.
- Chaplain – Offers spiritual care and support based on family preference and beliefs.
- Volunteer – Provides companionship, light assistance, and respite for caregivers.
- Medical Director and Physician – Oversees the care plan, coordinates with your primary doctor, and ensures symptom management is effective.
Learn more about your care team and services → Care Services
What’s Included:
All scheduled nursing and personal care visits -Medications for symptom management (pain, nausea, anxiety, breathlessness) -Medical equipment and supplies (hospital bed, oxygen, wheelchair, incontinence supplies) -24/7 phone access to registered nurses for questions or concerns. Regular care plan updates as condition changes
When It’s Appropriate: Routine Home Care is appropriate when symptoms are stable or manageable with regular nursing oversight, and family members or facility staff can provide basic care between hospice visits with phone support available.
Most patients spend the majority of their hospice journey on Routine Home Care, with brief transitions to other levels as needed.
Level 2: Continuous Care
What It Is: Continuous Care provides intensive, short-term nursing in your home during a medical crisis to manage acute symptoms and avoid hospitalization. A nurse “or hospice aide” stays in the home for extended periods sometimes up to 24 hours, to provide hands-on symptom management
Who Provides Care:
Registered Nurses and Licensed Practical Nurses Provide continuous bedside nursing care, monitoring vital signs, administering medications, managing pain crises, and adjusting treatment in real-time.
Certified Nursing Assistants (when needed) Assist with personal care during extended nursing shifts.
What’s Included:
- Continuous nursing presence at home (minimum 8 hours, up to 24 hours per day)
- Aggressive symptom management to stabilize pain, breathlessness, agitation, or other acute symptoms
- Frequent medication adjustments and monitoring
- Family education and emotional support during crisis -Coordination with hospice physician for care plan changes
When It’s Appropriate: Continuous Care is initiated when symptoms escalate suddenly and cannot be managed with routine visits alone: situations like uncontrolled pain, severe respiratory distress, acute agitation or delirium, seizures, or other symptom crises.
The goal is to avoid unnecessary hospitalization by bringing hospital-level nursing care into the home environment where your loved one is most comfortable.
How Long It Lasts: Continuous Care is temporary, typically lasting 24-72 hours until symptoms stabilize. Once the crisis resolves, your loved one transitions back to Routine Home Care.
There’s no penalty for needing Continuous Care, and it can be initiated multiple times if symptoms flare again later.
Level 3: Inpatient Respite Care
Inpatient Respite Care provides a short-term stay (up to five consecutive days) in a contracted skilled nursing facility or hospice inpatient unit to give family caregivers a much-needed break.
Who Provides Care:
- Facility Nursing Staff – Provides 24-hour care, medication management, personal care, and symptom monitoring in the inpatient setting.
- James River Home Health & Hospice Team – Continues to oversee care and coordinate with facility staff to ensure comfort and continuity.
What’s Included:
- Up to five days of inpatient care in a contracted facility
- All nursing care, medications, meals, and personal care during the stay
- Symptom management and monitoring
- Safe, comfortable environment with 24-hour supervision
When It’s Appropriate: Respite care is designed for family caregivers who are physically or emotionally exhausted and need time to rest, recover, or handle other responsibilities. It’s about supporting the caregiver’s wellbeing so they can continue providing care long-term.
Common reasons families use respite care:
- Primary caregiver needs surgery or medical treatment
- Caregiver is approaching burnout and needs rest
- Family needs time to travel for work or family obligations
- Caregiver becomes ill and temporarily cannot provide care
After respite care ends, your loved one returns home and Routine Home Care resumes.
Level 4: General Inpatient Care
General Inpatient Care provides short-term care in a hospital or hospice inpatient facility when symptoms are too severe or complex to manage at home, even with Continuous Care nursing.
Who Provides Care:
Inpatient Medical Team – Nurses, physicians, and support staff provide 24-hour hospital-level care focused on aggressive symptom management.
James River Home Health & Hospice Team Coordinates with the inpatient facility to ensure continuity of care and transition planning.
What’s Included:
- 24-hour inpatient nursing and physician care
- Advanced symptom management and monitoring
- Medications, IV therapy, and other interventions as needed
- Social work and chaplain services -Discharge planning and transition support
When It’s Appropriate: General Inpatient Care is used when acute symptoms cannot be safely or effectively managed at home.
How Long It Lasts: General Inpatient Care is temporary, typically lasting a few days to a week. Once symptoms are stabilized, your loved one transitions back home to Routine Home Care or remains in the facility if that’s more appropriate.
How We Transition Between Levels
You don’t have to request a level change or fill out paperwork. Our clinical team monitors your loved one’s condition continuously and adjusts the level of care based on what’s needed.
Here’s how it works:
- Assessment: Your nurse evaluates symptoms during regular visits and is available 24/7 if symptoms change suddenly.
- Clinical Decision: Our team determines which level of care is appropriate based on symptom severity, safety, and family capacity.
- Coordination: We handle all logistics, scheduling Continuous Care nurses, arranging facility placement for respite or inpatient care, coordinating with physicians, and communicating with family.
- Seamless Transition: Care shifts happen quickly and smoothly. If you call at midnight with a crisis, a Continuous Care nurse can be at your home within hours.
You focus on being present. We handle the rest.