Medicare sets four distinct levels of hospice so care can match what you need right now: Routine Home Care, Continuous Home Care, Inpatient Respite Care, and General Inpatient Care. Most days are Routine Home Care, and your level can change if symptoms spike or caregivers need temporary relief.
This guide explains each level in plain language, when it is used, and how coverage works in Colorado.
Why Hospice Uses Levels of Care
Hospice adjusts intensity so you get the right help at the right time. Federal rules require every Medicare-certified hospice to provide all four levels, and payers align payment with the level you receive that day. Colorado Medicaid follows the same framework for eligible members.
Understanding Each Level of Hospice Care
When people talk about the levels of hospice care, they are describing how much support you receive on a given day so your symptoms stay controlled and your caregiver has help. Your level is not a permanent label. It can change as needs change, and it follows clear Medicare rules that most insurers use.
Below, you will see what each level includes, when it is used, and how your hospice team decides which level fits you today.
Level 1: Routine Home Care
What It Is: The standard, ongoing level for most patients, provided wherever you live, including a private home, assisted living, or nursing facility. A typical week can include nurse visits, hospice aide support, medications and equipment for comfort, social work, chaplaincy, and 24/7 on-call help. Most hospice days nationwide are billed at this level.
When It Is Used: Your symptoms are reasonably controlled without continuous bedside care.
Example: Your nurse adjusts medication for shortness of breath, the aide helps with bathing, and the team checks on you several times a week with phone support available at night.
Level 2: Continuous Home Care
What It Is: Short-term, crisis-level support in the home when you have uncontrolled symptoms that require frequent nursing assessment and interventions for much of the day. Services are provided for at least 8 hours in a 24-hour period, mainly by nursing staff.
When It Is Used: Severe pain, breathing distress, or agitation that cannot be managed with routine visits but can be stabilized at home with intensive support.
Example: A nurse remains at the bedside for repeated medication titration and monitoring until symptoms settle.
Level 3: Inpatient Respite Care
What It Is: A short, planned inpatient stay to give family caregivers a break when you are otherwise stable. Provided in a Medicare-certified facility for up to five consecutive days per respite period.
When It Is Used: Your primary caregiver needs rest, has travel or medical appointments, or there is a short-term home disruption.
Example: You transfer to a contracted facility from Friday to Monday so your daughter can attend a family event. Hospice continues to manage your plan of care.
Level 4: General Inpatient Care
What It Is: Short-term inpatient care for pain or symptom management that cannot be achieved in the home. It must occur in a hospital, hospice inpatient unit, or skilled nursing facility with physician oversight.
When It Is Used: Uncontrolled pain, complicated wound care, severe nausea or vomiting, or complex medication needs that require rapid changes and close monitoring.
Example: You move to an inpatient setting for IV medications and continuous assessment. Once symptoms are controlled, you return home at the appropriate level.
How Levels Change As Needs Change
Illness does not move in a straight line. Hospice adjusts the intensity of care so you receive the right help on the right day.
- The hospice team reviews your symptoms and goals each day and assigns the appropriate level for that date of service.
- Most patients remain on Routine Home Care. National monitoring shows over 98 percent of hospice days billed as Routine Home Care, with very small portions for the other three levels.
If your symptoms flare, your level can increase for short periods and then return to Routine once you are comfortable. You and your caregiver are part of every decision, and insurance coverage follows the level assigned for that day.
Colorado Notes You Should Know
- Health First Colorado (Medicaid) covers hospice when eligibility is met. For members living in nursing facilities, room and board payments for Routine or Continuous Home Care flow through the hospice per state billing policy.
- State rules define hospice as a coordinated, 24-hour-available service that can be delivered at home or in licensed facilities.
Frequently Asked Questions
Can my level increase for only part of a day?
Levels are assigned per day based on what you need during that 24-hour period. If you had a crisis requiring continuous care, that day may be billed as Continuous Home Care.
Do I have a say in changing levels?
Yes. Levels reflect your symptoms and goals. Your nurse will explain options and involve you and your caregiver in every change.
Does insurance cover all four levels?
Medicare requires all four levels. Most commercial plans follow Medicare standards, and Colorado Medicaid aligns with this structure.
Signs You May Need a Higher Level Today
- Sudden, severe pain or breathlessness
- Restlessness, confusion, or anxiety not eased by current medications
- Repeated uncontrolled nausea or vomiting
- Caregiver exhaustion that makes safe care difficult at home
Call us if you notice several of these. We will help determine whether Continuous Home Care, General Inpatient Care, or a brief Respite stay is appropriate.
Start Hospice Care in Colorado Today
If you are unsure whether it is time for hospice, talk with a hospice team member now. Call (720) 999-9854 for a calm, step-by-step review of eligibility, help coordinating with your doctor, and a visit arranged as soon as possible.
You also reach us online. Bring any question. A nurse will meet you where you are, outline choices in clear terms, and help you take the next step that aligns with your goals. Your preferences guide every decision.
We are here seven days a week with 24/7 on-call support, offer same-day evaluations when possible, and extend one year of bereavement care for your family. We serve the Denver metro, including Arapahoe, Adams, Douglas, Jefferson, Weld, Boulder, Elbert, Broomfield, and nearby communities.