The Four Different Levels of Care

By Elder Law Attorney Rick Law.  Senior Advocate and Managing Partner at the Estate Planning Center at Law Elder Law in West Suburban Aurora, Illinois.

The very basic level of care is called “routine level of care”, which is the absolute minimum that Medicare expects a hospice to do.  That’s the very basic level of care  where a patient can be seen anywhere from daily to every 14 days by the nurse, a certified nursing assistant, the chaplain, or a social worker.

The next level is called “respite care.” Normally, seniors don’t qualify for skilled nursing care unless they’ve been in an acute-care hospital for at least 72 hours. The exception to that is hospice, for a patient living at home when the person caring for them becomes injured or sick or perhaps when there’s a fire in the house.

The hospice will pay for that patient to be transferred to a nursing home and the hospice will pay for five nights at that facility while they sort out the situation. Or, let’s say they’re living at home with a daughter or son who needs a break. The hospice can bring the ill person to a nursing home, and that’s one of the rare times that Medicare will pay for nursing home care without that initial acute-care hospitalization stay.

The third level of care is “continuous care” or “comfort care.” This is the most financially risky area of care for the hospice agency because it enables putting a nurse at the bedside to manage pain symptoms and end-of-life care. There are very specific criteria— certain combinations of nursing home hours versus CNA [certified nurse assistant] hours.

There are only so many hours per every 24-hour period that a patient receives care in order for the agency to be reimbursed. If they are off by even 15 minutes, the hospice may not get paid. But some hospices provide that level of care because it enables their patients to die at home. There are few agencies that do that.

The highest level of care is called “general inpatient care.” That is done in a facility where there’s a registered nurse on the premises at all times—a Medicare-accredited hospital setting or skilled nursing facility. It’s the only time that Medicare allows the hospice to pay room and board in a skilled area.

There are very specific criteria to qualify. An example would be somebody at home who is not doing well, but they would like to be around when their grandson comes home from college for a final goodbye. The decision might be made to take them to a hospital or nursing home to start an IV to get some hydration going and help make that wish come true.

Those are the four levels of care. All hospices do the routine level of care. Most will do respite care because there’s no financial risk involved. There are very few hospital-based hospices that do all four levels. It is very important to interview different hospice options to ask them what levels of care they will provide.

Too many families needlessly lose everything they have.  Don’t let that be you.  If you need help paying the overwhelming cost of long term care, give our office a call at 800-310-3100.  Your first consultation is absolutely free.  We’ll let you know what steps you need to take, right now, to protect yourself and your family.  Call now, because when you’re out of money, you’re out of options!


Rick L. Law, Attorney, Estate Planner for Retirees.

Rick was named the #1 Illinois elder law estate planning attorney by Leading Lawyer Magazine. He has been quoted in the Wall Street Journal, AARP Magazine,, and numerous newspapers and articles. Rick is the lead attorney for Law Elder Law, LLP, focusing in Estate Planning, Guardianship, and Nursing Home Solutions. His goal is to give retirees an informed edge when it comes to dealing with an uncertain future.  Get flexible retirement strategies that work during good times and bad, plus information on how you can save your home and assets from being used to pay for long term care.  Call 800-310-3100 for your free consultation now!

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