The four levels of hospice care
Medicare pays hospices for four levels of care. Most days are routine home care. The other three are for a crisis at home, a caregiver who needs rest, or symptoms that cannot be managed at home.
Checked against Medicare.gov, CMS and the federal rules on October 20, 2026. General information, not medical or legal advice.
The four levels at a glance
| Level | Where | When |
|---|---|---|
| Routine home care | At home | Most hospice days: the person is at home and not getting continuous care. |
| Continuous home care | At home | Brief periods of crisis, to keep the person at home. Mostly nursing care, at least 8 hours in a day. |
| Inpatient respite care | An approved facility | A short stay so the family caregiver can rest. Up to 5 days at a time, on an occasional basis. |
| General inpatient care | An inpatient facility | Pain control or symptom management that cannot be managed in other settings. |
Home can mean a private house, a nursing home or assisted living: wherever the person lives.
Routine home care
A routine home care day is a day the person is at home under hospice care and not receiving continuous care. Visits from the nurse, aide, social worker and others follow the plan of care. The hospice must keep nursing, doctor services and drugs available 24 hours a day, 7 days a week.
Continuous home care
During a period of crisis, nursing care can be given continuously, for as much as 24 hours a day, so the person can stay at home. A period of crisis is a time when the person needs continuous care to manage acute symptoms. Aide or homemaker services can be part of it, but the care must be mostly nursing care.
Medicare counts it as a continuous home care day only when at least 8 hours of care are given that day.
Inpatient respite care
Respite care is a short inpatient stay that gives the family or other caregivers a rest. It can be given only occasionally, and Medicare pays for no more than 5 days in a row at a time. The hospice arranges it in a hospice inpatient facility, a hospital or a nursing home that meets Medicare's standards.
Under Original Medicare you may pay 5% of the Medicare-approved amount for respite care.
General inpatient care
General inpatient care is for pain control or acute or chronic symptom management that cannot be managed in other settings. It is given in a Medicare-certified hospice inpatient facility, or in a hospital or skilled nursing facility that meets Medicare's standards for 24-hour nursing.
If someone goes to a hospital for the terminal illness without the hospice arranging it, the family might be responsible for the whole cost. Call the hospice first.
Common questions
Who decides the level of hospice care?
The hospice team sets the level in the plan of care, based on the person's needs. Ask the team if you think a different level is needed.
How long can hospice respite care last?
Up to 5 days in a row at a time. It can be used more than once, but only occasionally.
Is continuous home care the same as 24-hour care at home?
Not quite. It is for short periods of crisis, is mostly nursing care, and counts only on days with at least 8 hours of care.
Sources
- 42 CFR 418.302: Payment procedures for hospice care (eCFR (42 CFR Part 418))
- 42 CFR 418.204: Special coverage requirements (eCFR (42 CFR Part 418))
- 42 CFR 418.108: Short-term inpatient care (eCFR (42 CFR Part 418))
- Medicare Hospice Benefits (publication 02154) (Medicare.gov)
- 42 CFR 418.100: Organization and administration of services (eCFR (42 CFR Part 418))
Find a hospice near you
See Medicare’s family survey results for hospices near a home address.