The 4 Levels of Hospice Care Explained

Medicare hospice care comes in four levels, and the hospice team moves a patient between them based on what the person needs that day. Most care is the everyday, at-home level; the others exist for crises and short breaks. Understanding the four prevents the most common surprise — expecting round-the-clock staffing when the standard level is intermittent visits.

The four levels at a glance

Level	Where	What it's for
Routine Home Care	Wherever you live (home, assisted living, nursing home)	The everyday level — scheduled team visits, symptom management, medications, equipment. Most common by far.
Continuous Home Care (CHC)	In the home	Short periods of mostly nursing care during a medical crisis to keep the patient comfortable and avoid the hospital.
General Inpatient Care (GIP)	In a facility (hospice unit, hospital, or nursing facility)	Acute symptom crisis that can't be managed at home — short-term, until symptoms are back under control.
Inpatient Respite	In a facility	A short stay to give the family caregiver a break — up to 5 consecutive days at a time.

1. Routine Home Care

This is hospice as most families experience it. The team — nurse, aide, social worker, chaplain — visits on a schedule wherever the patient lives, with a nurse reachable 24/7 by phone. Aide visits are intermittent (help with bathing and personal care a few times a week), not all-day staffing. Between visits, family or hired caregivers provide the hands-on, hour-to-hour care.

2. Continuous Home Care (CHC)

When a patient hits a short-term medical crisis at home — for example, sudden uncontrolled pain or severe breathing distress — the hospice can bring in intensive, predominantly nursing care for a stretch of hours to stabilize them at home and avoid hospitalization. It is crisis care, not daily help: it's triggered by clinical need, authorized by the hospice, and ends once the crisis is controlled. Most patients never need it.

3. General Inpatient Care (GIP)

If symptoms become too severe to control at home — say, a pain or breathing crisis requiring close monitoring — the patient may move temporarily to a facility (a hospice inpatient unit, hospital, or contracted nursing facility) for round-the-clock clinical management. GIP is short-term: the goal is to get symptoms back under control and then return the patient to routine care, usually at home. Read more in what is general inpatient hospice care.

4. Inpatient Respite Care

This level exists for the caregiver, not a medical emergency. The patient stays briefly in a facility — up to 5 consecutive days per stay — so an exhausted family caregiver can rest, travel, or recover. A small coinsurance of 5% of the Medicare-approved amount can apply to a respite stay. It's occasional relief, repeatable as needed under the hospice's plan, and a genuine lifeline when you're worn down. See what is respite care in hospice.

What each level costs you

The Medicare Hospice Benefit covers the care at every level, but a couple of small charges and one big non-covered item are worth knowing:

• Routine Home Care: covered. Outpatient symptom medications may carry a copay of up to $5 per prescription. Facility room and board is not covered — see does hospice cover room and board.
• Continuous Home Care: covered as a crisis intervention; no separate room charge because it happens in your own home.
• General Inpatient Care: the facility bed is covered because GIP is a covered level of care — you are not separately billed for room and board during a GIP stay.
• Inpatient Respite: covered, with a 5% coinsurance of the Medicare-approved amount; limited to up to 5 consecutive days per stay.

The key distinction: under Routine Home Care in a nursing home or assisted living, hospice pays for the care but not the bed. GIP and respite are the two levels where the hospice benefit covers the facility bed itself.

The misconception, corrected

Many families assume signing up for hospice means a caregiver will be in the home around the clock. The standard level — Routine Home Care — is visiting care plus 24/7 phone support, not 24-hour staffing. The two levels that add more hours, CHC and GIP, are reserved for short crises and end when the crisis passes. If you need continuous coverage at home, you'll arrange and usually pay for that separately; see does hospice pay for 24-hour care or caregivers at home.

How the team chooses a level

You don't pick a level from a menu — the hospice matches it to clinical need, and the level can change day to day. Most people stay on Routine Home Care the entire time. CHC and GIP are entered only during a genuine crisis and are left as soon as symptoms are controlled, returning the patient to routine care. Respite is the one level you can actively request: when you, the caregiver, are exhausted, ask the team to arrange a respite stay. Because levels shift, the cost and setting can shift too — importantly, hospice covers the care, but in a long-term setting like a nursing home it generally does not cover room and board.

How a single bad night can move through the levels

It helps to see the levels in motion. Imagine a patient on Routine Home Care whose pain spikes severely one evening. The family calls the 24/7 line; the on-call nurse comes out and, finding the pain hard to control, the hospice authorizes Continuous Home Care — a nurse stays for several hours adjusting medication. If that stabilizes things, the patient stays home and returns to routine care by morning. If it doesn't, the team may move the patient to a facility for General Inpatient Care until the crisis is controlled, then bring them back home. A week later, with the caregiver exhausted from the ordeal, the family requests Inpatient Respite so they can sleep. One patient, one week, all four levels — each used for exactly what it's designed for. This fluidity is the point: care intensifies when needed and eases back when the crisis passes.

Frequently asked questions

Can I ask to be moved to a higher level of care?

You can request respite directly, and you should call the 24/7 line during any crisis so the nurse can assess whether CHC or GIP is warranted. CHC and GIP are authorized based on clinical need, not chosen from a menu, but your call is what triggers the assessment.

How long can General Inpatient Care last?

GIP is short-term by design — it lasts only as long as the symptom crisis requires close facility-level management. Once symptoms are controlled, the patient returns to routine care, usually at home.

Is Continuous Home Care the same as 24-hour care?

No. CHC is intensive, mostly nursing care during a crisis for a stretch of hours; it is not ongoing custodial staffing. When the crisis resolves, it ends.

Does the respite limit reset?

Respite is limited to up to 5 consecutive days per stay, and it can be used on an occasional basis under the hospice's plan of care. Ask your team how they apply it to your situation.

Questions to ask your hospice

• What level are we on now, and what would trigger a change?
• How do I reach you during a crisis, and how fast can a nurse get here?
• If symptoms can't be controlled at home, where would a GIP stay happen?
• How do I request a respite stay when I'm worn out?

Practical next step

Ask your hospice: “What level are we on now, and what would trigger a change — and how do I request respite when I'm exhausted?” Knowing the four levels helps you advocate for the right care at the right moment instead of suffering through a crisis. To see how the team delivers each level, read what a hospice care team does, or compare hospices near you.