Levels of care within Legacy Hospice
Your attending physician, in coordination with your hospice nurse and hospice team will
determine which level of care that you or your loved one is appropriate for. These are the
four levels of care that you may hear described and when they may be utilized.
1. Routine Home Care (most commonly used).
 Patients “home” environment is described as wherever they currently
reside at the start of hospice services. This can take place in a residential
home, nursing home, assisted-living, personal care home.
 When is it used?
o For a patient to be in Routine Home Care, the patient is declining
but not exhibiting any uncontrolled symptoms.
 Routine home visits will be provided by all accepted hospice staff
members (nurse, home health aide, social worker, spiritual care
coordinator, bereavement coordinator, volunteers) as determined in the
current plan of care.
2. Continuous Care/ Crisis Care
 The goal is a short-term management of an uncontrolled symptom with a
preference for the patient to remain in their home.
 When is it used?
o When a patient is having a “medical crisis.”
 Examples include, uncontrolled severe pain, nausea,
vomiting, difficulty breathing.
 Continuous care is meant to keep the patient in their current home
environment. It is a short-term intervention where the patient will receive
a minimum of 8 hours of hospice support in the home within a 24 hour
period. The 8 hours is not always continuous, but 50 percent of the time
must be by a licensed nurse, and 50 percent can be by hospice aides.
 An order by the attending physician in coordination with the hospice nurse
will end the need for continuous care and return the patient to routine
home care when their needs are now being managed.
3. General In-patient
 The goal is a short-term management of an uncontrolled symptom related
to their terminal diagnosis (why they are on hospice) when a patient
cannot be managed effectively in their home environment.
 When is it used?
o Examples include intractable pain, intractable nausea or vomiting,
severe difficulty breathing.
 The patient will be transferred to a place with 24 hour nursing care.
Usually in a hospital or a Medicare and/or Medicaid-certified skilled
nursing home. During this time only will hospice cover room and board.
 This is determined by hospice staff and the attending physician.

(general inpatient continued)

Sending your loved one to a hospital without consent or knowledge by
the hospice team does not mean that hospice will pay for the room and
board and the hospital services during their stay. You may be
responsible for the bill. Your primary insurance also may not cover
the expenses due to your status on hospice.
4. Inpatient Respite
 The goal is a temporary respite (or rest) to relieve a caregiver of their
caregiving duties when caring for a patient in their residential home.
 The hospice staff will arrange a stay for the patient in a contracted nursing
facility for up to 5 calendar days.
 During this time only will hospice pay for room and board, as contracted
with the facility.
 The patient will continue to receive visits and support from Legacy
Hospice staff during their respite stay, and coordinate their care needs with
the facility.
 After their respite stay they will return to their home environment and the
primary caregiver will resume providing their caregiving duties to the
patient.
 The patient must return home on the 5th day, or the patient or family must
have a contracted agreement with the facility to pay privately from the 6th
day on.
 Families may use the respite benefit more than once while their loved one
is on hospice services but overly using the respite benefit may trigger
discussions from the hospice staff to look at the home environment to see
if extra supports need to be evaluated.