What Families Should Understand About the Four Levels of Hospice Care
Hospice care focuses on alleviating suffering and maintaining quality of life and comfort for patients who are terminally ill, along with their families. Hospice provides palliative support, instead of working toward a cure.
The Medicare hospice benefit distinguishes between four levels of hospice care based on different medical care and caregiving needs. Being aware of these four levels of care enables families to understand how, where, and when care is provided; and what decisions can be made if changes in circumstances arise.
Level 1: Routine Home Care
RHC is the most widely used hospice level of care and accounts for over 98% of hospice days. RHC takes place wherever the patient lives; including the patient's home, an assisted living facility, a nursing home, or other surroundings.
RHC includes:
Visits by nurses, home health aides, social workers, and chaplains, as needed by the patient.
Symptom management along with pain control, including essential medical equipment like oxygen, wheelchairs, and hospital beds.
Emotional and spiritual support for both patients and their families.
Medications associated with the terminal illness to comfort and relieve discomfort.
Level 1 is appropriate for patients who manage their symptoms and symptoms are stable - to allow them to remain in familiar surroundings with the care and support service they have received consistently.
Level 2: Continuous Home Care
When a patient experiences a crisis—such as uncontrolled pain, severe shortness of breath, or anxiety—routine care may not be enough. That’s where Continuous Home Care comes in.
CHC provides:
24-hour care—from a minimum of 8 hours to full-time depending on the crisis.
Focused support to stabilize symptoms and transition the patient back to routine care.
Staffing by licensed nurses (RN, LPN), with certified nursing assistants (CNA) added if needed.
This level is temporary and activated only during acute flare-ups that cannot be managed through routine visits.
Level 3: General Inpatient Care
If symptoms cannot be controlled at home—even with continuous care—patients may be admitted to a hospice center, hospital, or skilled nursing facility for round-the-clock treatment.
GIC includes:
Short-term hospitalization to quickly stabilize symptoms.
Specialized, 24/7 support by a professional medical team with access to advanced equipment and medications.
Transition back to RHC once the patient's condition improves.
This level is reserved purely for situations too complex to handle safely at home.
Level 4: Inpatient Respite Care
Caring for a loved one is emotionally and physically demanding. Respite care gives caregivers the temporary break they need.
IRC offers:
A short-term stay (up to 5 days) in a hospice facility or similar setting.
Routine care, equivalent to RHC but provided off-site.
A chance for caregivers to rest and recharge, ensuring long-term care is sustainable.
Transitions Between Levels
The hospice team—doctors, nurses, social workers, and others—determine when it’s time to shift between levels based on patient needs. Families don’t request transitions; the team does.
From RHC → CHC or GIC: triggered by uncontrollable symptoms.
From CHC or GIC → RHC: happens once symptoms stabilize.
From RHC → IRC: based on caregiver needs, not the patient’s condition.
Key Takeaways for Families
Hospice is a service—not a place. Care usually happens at home, with facility-based care reserved for crises or caregiver relief.
Flexibility is built in. Hospice adjusts as patient needs evolve.
Your hospice team is your ally. Ask questions, understand what's coming next, and know what each level means for care and comfort.
Caregiver support is vital. IRC exists for a reason—don't hesitate to use it.
How LIEM Hospice Illustrates These Principles
LIEM Hospice, serving the greater Los Angeles area, exemplifies how these four levels work in real life. They view hospice as a philosophy, not a location—care comes to you, wherever you call home. Their approach is built around compassion, dignity, and personalized care.
Their team offers Routine Care in the patient’s preferred setting, Continuous Care during crises, General Inpatient Care when symptoms need hospital-level attention, and Respite Care for caregiver relief—all aligned with Medicare’s four levels.
LIEM emphasizes that hospice is about more than medical treatment—it also supports emotional, spiritual, and psychological needs.
Their message reinforces that hospice is not giving up, but choosing comfort and dignity in life’s final chapter.
Final Thought for Families
When you understand the four levels of hospice care, you’re empowered to make informed decisions. You’ll know what to expect, where your loved one will be, and what support is available for both patient and caregiver.
Providers like LIEM Hospice offer a real-world example of how hospice can adapt to changing needs while preserving dignity, comfort, and peace—for both patients and their families.