Levels of Care

Levels of Care

At Golden Rule Hospice, we offer five levels of care. These include the four levels of care that Medicare covers, along with an additional level of care called Transitional Care.

1. Routine Home Care

One of our goals at Golden Rule is to ensure that our patients can spend as much time at home as possible.

With Routine Home Care, our interdisciplinary team visits the patient in their residence. That might be their home, your home, an assisted living facility, a nursing home, or another location.

We administer care at home so that patients can stay where they feel safest and most at ease with minimal disruptions.

2. Continuous Care

This level of care also takes place in the patient’s home. Whereas routine home care is about the management of daily symptoms and needs, Continuous Care is what we provide during a medical crisis.

What constitutes a crisis is based on Medicare’s definitions, since Medicare covers the cost of this level of care.

The Centers for Medicare and Medicaid Services (CMS) regulations state: “Continuous home care may only be provided during a period of crisis, as necessary to maintain an individual at home. A period of crisis is a period in which a patient requires continuous care that is predominantly nursing care to achieve palliation or management of acute medical symptoms.”

Symptoms which call for continuous care include:

• Severe unmanageable pain
• Bleeding from various orifices
• Acute respiratory distress that cannot be managed with medications
• Unrelenting nausea and vomiting
• Terminal agitation or restlessness

During each 24-hour period, we administer care for a minimum of 8 hours. This is a short-term service, unlike Routine Care and is revisited every 24 hours.

Continuous Care is one of two levels of care that fall into the category of “Supportive Care.” The other is Transitional Care.

3. Respite Care

Respite is a service in which the patient is placed in a contracted nursing facility, contracted hospital, or an inpatient facility, for up to 5 consecutive days.

This type of care allows the caregiver to rest. It also allows the caregiver to fulfill obligations that may take them out of town or provide time for healing, if they encounter a medical emergency.

Finally, burnout provides sufficient grounds to request Respite Care. Caregiver burnout and compassion fatigue can have serious health consequences for both caretaker and dependent. For that reason, Respite Care is available to offer a much-needed break.

4. In-Patient Care

At times, it may be necessary for a patient to be treated in a clinical setting, such as a contracted hospital, contracted nursing facility, or an in-patient facility. In-patient care usually lasts 8 days or less.

With In-Patient Care, our goal is to get the patient’s symptoms under control so that they can return to at-home care.

Here are some symptoms which would warrant in-patient care:

• Severe acute pain that cannot be controlled outside a clinical setting
• Nausea and vomiting that cannot be controlled outside a clinical setting
• Respiratory distress requiring clinical intervention
• Continuous or complex wound care
• Seizures that are uncontrolled

Those are just some examples. There are other cases that necessitate In-Patient Care as well.

Golden Rule uses In-Patient Care facilities that offer peaceful, comfortable environments for patients. Homey, inviting settings and caring staff help patients to feel as “at home” as possible while they are under In-Patient care.

Transitional Care

Transitional Care is a benefit unique to Golden Rule Hospice. Routine Home Care, Continuous Care, Respite Care, and In-Patient Care are all covered by the Hospice Medicare benefit. At Golden Rule Hospice, we know that there will be times when additional supportive care is needed. When we identify that a hospice patient is actively declining and they do not qualify for Continuous Care under CMS’ regulation but additional support is needed, Transitional Care is initiated.

Here are some examples of types of decline that may make Transitional Care an option:

• An unarousable or comatose state
• A decrease in vital signs (blood pressure, pulse, and irregular respirations)
• An increase in temperature
• A decrease in urine output

Should one of these types of decline take place, we contact the family and ask whether they would like to receive support through our Transitional Care program.

Transitional Care is not a reimbursable level of care. It is strictly a supportive care service by Golden Rule Hospice. Support is often provided by a certified nursing assistant.

The goal of Supportive Care is to ensure that our patients transition with peace and dignity and the family can focus on their loved ones.