Choosing the right hospice care level can feel overwhelming in the first days after a referral. You want your loved one comfortable and safe, yet the options and terms are not always clear. You are not alone in this. 

As a Medicare-certified hospice serving Burbank and Los Angeles County, our team walks families through each level in plain language, explains where most people begin, and shows the signs that it is time to adjust care. This guide gives you a simple checklist and a clear plan so you can make confident decisions with your nurse and social worker.

How Hospice Levels Work

Medicare recognizes four levels of hospice care: Routine Home Care, Continuous Home Care, General Inpatient Care, and Inpatient Respite Care. All Medicare-certified hospices offer these levels so support can match changing needs.

Most families begin with Routine Home Care at home or in a facility. If symptoms spike or caregivers are overwhelmed, the team can step up to Continuous Home Care in the home or General Inpatient Care in a hospital or contracted inpatient unit. Inpatient Respite Care offers up to five days of short-term relief for family caregivers when a safe break is needed.

Tip: Your care level is not a grade. It is simply a way to match the right amount of help to what is happening today.

Level 1: Routine Home Care

What it looks like: Regular visits from your hospice nurse, home health aide, social worker, chaplain, and other team members. Medications, medical equipment, and supplies related to the terminal diagnosis are included when medically necessary and part of the plan of care. 

Good fit when:

• Pain, nausea, shortness of breath, or anxiety are generally controlled
• You have a safe environment and a caregiver or staff support in a facility
• You need education, check-ins, and adjustments rather than around-the-clock nursing

Common goals: Build trust, set up equipment, fine-tune medications, teach simple routines, and keep you as comfortable as possible at home.

Level 2: Continuous Home Care

What it looks like: Short-term, extended hours from hospice nurses and aides at home during a medical crisis, so symptoms can be stabilized without moving to the hospital. Medicare defines this level as at least 8 hours of care in a 24-hour day, with more than half of the hours provided by a nurse (RN, LVN, or LPN). Care is delivered only during brief periods when it is necessary to maintain the person at home. 

Good fit when:

• There is rapid change such as uncontrolled pain, severe agitation, respiratory distress, frequent seizures, or relentless vomiting
• There is a temporary collapse of the caregiver plan, and skilled nursing is needed to keep the person safe at home while the team stabilizes the situation 

Common goals: Fast medication titration, close monitoring, intensive teaching for caregivers, and prevention of unwanted hospital trips.

Level 3: General Inpatient Care

What it looks like: Short-term care in a hospital, contracted hospice inpatient unit, or skilled nursing facility for symptom control that cannot be safely managed at home. The focus remains comfort and relief. 

Good fit when:

• Symptoms cannot be stabilized at home despite appropriate changes
• You need frequent assessments, IV medications, or continuous monitoring that home cannot support

Common goals: Rapid stabilization in a controlled setting, then a return to home or facility once symptoms are under control.

Level 4: Inpatient Respite Care

What it looks like: A short stay of up to five days in a Medicare-approved facility to give family caregivers needed rest or to bridge a temporary gap in coverage, then a return home. 

Good fit when:

• Your primary caregiver is exhausted, ill, traveling, or needs time to reset
• You are stable, but supervision is required and there is no back-up at home

How to Tell Which Level You Need Right Now

Use these questions with your nurse to match the level to today’s needs:

• Symptom control: Are pain, breathing, agitation, or nausea stable with current medications and visit frequency? If not, Continuous Home Care or General Inpatient Care may be appropriate.
• Safety: Can your loved one be safely cared for at home with scheduled visits and phone support? If not, discuss stepping up support. 
• Caregiver capacity: Has there been a temporary collapse of the caregiver plan due to exhaustion or sudden change? That can qualify as a crisis for Continuous Home Care to maintain care at home. 
• Setting needs: Do symptoms require interventions not feasible at home such as IV titrations or continuous monitoring? Consider General Inpatient Care to stabilize, then step back down.
• Rest for family: Would a planned break prevent burnout and keep care sustainable? Ask about Inpatient Respite Care for up to five days.

Signs It Is Time to Adjust Your Hospice Care Level

It is common to do everything right and still see new needs emerge. Trust your instincts. If any of the signs below appear, call your hospice nurse to review the plan and discuss a short-term increase in support.

Symptom changes

• Pain breaks through before the next scheduled dose
• New or worsening shortness of breath at rest
• Agitation, restlessness, or confusion that does not settle with current comfort measures
• Multiple seizures or new continuous vomiting

Care needs and safety

• New dependence with getting out of bed, toileting, bathing, or eating that exceeds current support
• Frequent medication changes or a need for IV or subcutaneous routes
• Falls or near-falls, or family feeling unable to keep the person safe overnight

Caregiver capacity

• Exhaustion, illness, or a sudden gap in available help
• Caregiver feels scared to be alone with the patient overnight

What happens next

• Your team may recommend a short period of Continuous Home Care to stabilize symptoms at home
• If symptoms cannot be controlled at home, a brief General Inpatient stay may be appropriate
• The team reassesses often and steps support back down as soon as it is safe

Quick check
If two or more signs are present, call your nurse now to match today’s needs with the right level of care.

What Medicare Covers

Medicare Part A covers hospice services related to the terminal diagnosis when provided by a Medicare-certified hospice, including team visits, medications, equipment, and supplies in the plan of care. There may be a small coinsurance for some outpatient drugs and a limited coinsurance for respite stays. Room and board are generally not covered in a non-contracted facility. Your social worker will review details for your specific situation. 

A Simple Plan for Families

1. Start with a conversation. Share your top three worries with the nurse. This keeps the plan focused on what matters most to you today.
2. Match the level to the need. Decide together whether Routine, Continuous Home, Inpatient, or Respite fits the next 24 to 72 hours. 
3. Set check-in times. Agree on when the team will call or visit again, and what would trigger an earlier call.
4. Prepare your home. Ensure the bed, lighting, and pathways are safe. Review how to use each piece of equipment.
5. Keep a symptom journal. Jot down pain scores, breathing changes, sleep, or new concerns. Bring it to every check-in.
6. Reassess often. Levels can change more than once. The goal is comfort, safety, and dignity at every step.

Call When You Are Unsure

Get help to match the right hospice care level. Speak with a nurse who will review symptoms, explain options, and create a right-now plan that fits your goals. Call (818) 748-3427 or reach us online. We support families in Burbank, Los Angeles County, Ventura County, Riverside County, Kern County, and Orange County.

You choose the setting that feels right. Our team centers your goals, values, and daily routine.