inpatient hospice care

Inpatient Hospice Care  – Definition, Benefits, Costs & FAQs


Hospice care is the first solution for comfort care at home for people with terminal illnesses. It provides comfort, support, and dignity when doctors determine the patient’s life expectancy is limited to 6 months or less if the disease follows its normal course.

But severe pain or other symptoms request an advanced level of care that is more efficiently delivered during a short stay in an inpatient hospice unit. The holy grail here is to control serious pain and symptoms so that patients can return home to their family and receive hospice care at home.

What is Inpatient Hospice?

This kind of hospice is taken where people live, most often at home, but also in nursing-home and assisted-living communities. When making a choice, home is where seven out of ten Americans wish to be at the final life stage.

This level of hospice care requires an interdisciplinary team that cares for patients and their relatives using a comprehensive approach. The core team of an inpatient hospice involves nurses and needs ready access to a trained physician. The extended team comprises psychologists, social workers, physiotherapists, speech/language therapists, occupational therapists, spiritual caregivers, dietitians, and voluntary workers.

Nursing staff should include at least 1, and preferably 1.2, nurses per bed. A doctor trained in palliative care should be available 24 hours a day. There should be dedicated input from psychosocial/spiritual care workers and voluntary workers.

What is Inpatient Care?



It’s a medical treatment for a patient whose condition necessitates hospice care in hospital or other health care setting, and the patient is formally admitted to the facility by a physician. Inpatient care tends to be directed towards more severe ailments and trauma that need one or more days of an overnight stay at a hospital. Due to healthcare coverage, health insurance plans require you to be formally admitted into a hospital to a stay for a service to become inpatient.

In-patient care is broken into two sections – the facility fee and those related to the physician/surgeon. Generally, copayments for inpatient services are structured either on a per day or per stay basis for the facility.

When you or your loved one experiences symptoms severe enough that they can’t be threatened at home, it’s time for inpatient care at a hospice facility or hospital.

These are the Medicare inpatient hospice criteria:

  • Sudden atrophy demanding intensive nursing intervention;
  • Uncontrolled pain, epilepsy, vomiting, and nausea;
  • Pathologic fractures;
  • Unmanageable respiratory distress;
  • Symptom relief through intravenous medications that need close monitoring;
  • Wound care requiring complex and/or frequent dressing changes that can’t be done in the patient’s home;
  • Minor procedures help the patient’s comfort, including inserting a permanent drain or removing fluid from the belly area.
  • Acute, ungovernable, agitated delirium, lifelong anxiety/depression secondary to the end-stage illness process, requesting intensive intervention.
inpatient hospice definition

How Long Can Patient Stay in Inpatient Hospice?



In case you live longer than six months, you can still get inpatient hospice care, as long as the medical director or other hospice physician recertifies that you’re terminal patient. You can receive hospice care for two 90-day benefit periods, or an unlimited number of 60-day benefit periods.


When Is Patient Discharged from Inpatient Hospice Care?

This sort of patient’s care is temporary, letting patients return home and family as soon as possible. The following criteriums show a patient may be ready to discharge from inpatient care:

  • Patient’s condition is stabilized;
  • The patient has moved to another level of care;
  • Medication required for skilled nursing care is no longer needed.

How Much Does It Cost?

According to the level of care required, Medicare usually ends up paying the most of hospice services, which for inpatient stays can often come up to $10,000 per month. On average, however, it’s usually around $150 for home care and up to $500 for general inpatient care per day.


Who Pays for It?

Medicare Part A covers the cost of hospice care related to a hospice-eligible patient’s terminal illness, with no copay or deductible. Medicare Part B (Medical Insurance) covers certain physicians’ services, medical supplies, and preventive services. For those with Medicare Advantage, hospice is covered by original Medicare. Patients that use a private or employer-provided health plan need to check with their insurance provider for information about hospice eligibility, coverage, and out-of-pocket expenses. Medicaid encompasses hospice coverage, but it differs by state.

hospice care in hospital

Home Hospice vs Inpatient Hospice

The majority of people think that hospice is all about going to or ending up in a place. Hospice is something totally different. It’s a unique philosophy of care that concentrates on improving comfort and overall quality of life during the last months of life.

Hospice care extends to wherever an acutely ill patient calls home — a private residence, nursing home, or assisted living community. A multi-professional team — doctor, nurse, hospice aide, chaplain, social worker, and volunteer delivers clinical, holistic hospice services to patients wherever they live.

When symptoms become quite difficult to manage at home, the patient has to be transferred to an inpatient facility. It could be a contracted hospice bed in a nearby hospice inpatient unit or a healthcare facility.


Inpatient Hospice Care vs. Outpatient Hospice Care

When most Americans hear term hospice care, they think of it as an inpatient service at a hospital or a nursing home. Still, hospice care can be delivered on an inpatient or an outpatient basis, meaning that it can also be provided in your home.

In case you or your loved one needs hospice care, the first thing you’ll have to interpret is what level of care he/she will require and whether that will be considered inpatient or outpatient hospice care. Whether the care is defined as outpatient or inpatient will define what Medicare covers – meaning that the services are either regulated, or you have some bulky medical bills to pay.

FAQs


Can a hospital refer an acute care patient to hospice for the inpatient level of care?

Yes, if the patient meets the criterium for the general inpatient level of care. Only the hospice can determine whether or not the patient is eligible.

Is a physician’s order required for transfer to the inpatient level of care?

A physician’s order is required for a change in the level of care as well as changes in the frequency of services.

What is the hospice role if a patient is admitted to the hospital for a condition not related to the terminal illness?

The hospice continues to deal with the terminal diagnosis and bills for routine home care.

If a patient transferred to a non-contracted hospital for a condition related to the terminal illness, is admitted and satisfies inpatient hospice criteria, what is the obligation of the hospice?

Documentation should display patient and family education regarding contracted facilities and the hospice’s role in professionally managing care. The hospice should attempt to obtain a one-time contract for this admission only. The hospice can help transfer the patient to a contracted facility if the condition of the patient allows, or it can have the patient/family be given an ABN (Advance Beneficiary Notice), or the patient has the option of revoking the hospice benefit. The hospital is responsible for issuing a Hospital Notice of NonCoverage to the beneficiary.

Does a 3 day stay for the hospice inpatient treatment in an acute care hospital qualify a patient for the 100-day SNF?

If a hospice patient receives general inpatient care for three days or more, he/she would be covered for SNF services, but only if the GIP services were provided in a hospital, not an SNF (skilled nursing facility) or free-standing inpatient hospice facility.

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