Inpatient Hospice Care

When your loved one’s comfort and symptom management needs become too complex for home care, inpatient hospice care can provide the specialized medical attention they deserve in a peaceful, supportive environment. Making the decision to transition from home-based hospice to inpatient care can feel overwhelming, but understanding what inpatient hospice offers can help you feel more confident in choosing the best path forward for your family.

At Serenity Palliative & Hospice Care, we understand that every family’s journey is unique. Sometimes, despite our best efforts to keep patients comfortable at home, medical needs arise that require the intensive care and monitoring that only an inpatient setting can provide. This guide will help you understand when inpatient hospice care might be appropriate, what to expect, and how to navigate this important decision with your loved one’s comfort and dignity as the top priority.

When Symptoms Can’t Be Managed at Home

The decision to move from home-based hospice to inpatient care is never taken lightly. This transition typically occurs when your loved one’s symptoms become too severe or complex to manage safely and effectively in a home environment, even with skilled nursing visits and family support.

Uncontrolled Pain: Sometimes pain becomes so severe that it requires constant monitoring and frequent medication adjustments that exceed what can be safely provided at home. In these situations, inpatient care allows for round-the-clock nursing supervision and immediate response to changing comfort needs.

Breathing Difficulties: Respiratory symptoms can escalate quickly and may require specialized equipment, oxygen therapy, or medications that need professional monitoring. When breathing becomes labored or frightening for both the patient and family, inpatient care can provide immediate relief and ongoing respiratory support.

Severe Nausea and Vomiting: Persistent nausea and vomiting can prevent your loved one from keeping down medications or fluids, leading to dehydration and increased discomfort. Inpatient care can provide IV medications and fluids to manage these symptoms more effectively.

Family Caregiver Exhaustion: Sometimes the decision for inpatient care isn’t just about medical needs but also about family capacity. When family caregivers are overwhelmed, exhausted, or unable to provide the level of care needed, inpatient hospice can offer both patient comfort and family respite.

Safety Concerns: Confusion, agitation, or mobility issues can create safety risks at home. Inpatient facilities are equipped to handle these challenges while maintaining your loved one’s dignity and comfort.

What Qualifies for Inpatient Hospice Care?

Inpatient hospice care is reserved for situations where symptoms cannot be managed in other settings, and specific criteria must be met for this level of care to be appropriate and covered by insurance.

Medical Necessity: The primary qualification is that symptoms related to your loved one’s terminal diagnosis require acute symptom management that cannot be provided in a home or outpatient setting. This determination is made by the hospice physician and medical team based on clinical assessment.

Symptom Severity: Qualifying symptoms typically include uncontrolled pain, severe respiratory distress, intractable nausea and vomiting, seizures, or other symptoms that require frequent monitoring and medication adjustments.

Failed Outpatient Management: Generally, there must be documentation that attempts to manage symptoms at home or in other settings have been unsuccessful. This doesn’t mean families have failed – it simply means the complexity of care has exceeded what can be safely provided outside a specialized facility.

Temporary Nature: Inpatient hospice care is intended to be temporary, focused on getting symptoms under control so that your loved one can return to a more comfortable setting when possible, whether that’s home or a long-term care facility.

Physician Certification: The hospice physician must certify that inpatient care is necessary and that the patient meets the criteria for this level of care. This certification is required for insurance coverage and must be renewed periodically if the stay extends beyond initial projections.

Where Is Inpatient Hospice Care Provided?

Inpatient hospice care can be provided in several different settings, each offering specialized environments designed to maximize comfort and support for both patients and families.

Dedicated Hospice Facilities: These are standalone facilities designed specifically for hospice care, offering a homelike environment with specialized staff trained in comfort care. These facilities often have features like family rooms, kitchens for family use, and peaceful outdoor spaces.

Hospice Units in Hospitals: Many hospitals have dedicated hospice units that provide inpatient hospice care within the hospital setting. These units combine the medical resources of a hospital with the comfort-focused philosophy of hospice care.

Skilled Nursing Facilities: Some skilled nursing facilities have contracts with hospice organizations to provide inpatient hospice care. These arrangements allow patients to receive intensive hospice services while benefiting from the 24-hour nursing care available in skilled facilities.

Specialized Palliative Care Units: Some medical centers have palliative care units that can provide inpatient hospice care, offering specialized expertise in symptom management and comfort care.

The choice of setting often depends on availability, your loved one’s specific medical needs, family preferences, and what facilities your hospice organization has agreements with in your area.

Inpatient Care: One of the Four Levels of Care

Understanding inpatient hospice care is easier when you know how it fits into the complete spectrum of hospice services. Hospice care is provided at four distinct levels, each designed to meet different needs and circumstances.

Routine Home Care: This is the most common level of hospice care, where services are provided in your loved one’s home, assisted living facility, or skilled nursing facility. The hospice team visits regularly, but the patient remains in their familiar environment with family providing much of the day-to-day care.

Continuous Home Care: This level provides intensive nursing care in the home during periods of crisis, typically lasting 8-24 hours. It’s designed to help manage acute symptoms at home when possible, avoiding the need for inpatient care.

Inpatient Respite Care: This temporary inpatient care (up to five days) is designed to give family caregivers a break. It’s not necessarily for acute symptom management but rather to provide family members with time to rest and recharge.

General Inpatient Care: This is the level we’re discussing in this article – intensive inpatient care for acute symptom management that cannot be provided in other settings.

Each level of care serves a specific purpose, and patients may move between levels as their needs change. The goal is always to provide the right level of care at the right time to ensure maximum comfort and quality of life.

What Is Inpatient Hospice Care?

Inpatient hospice care represents an intensive, specialized approach to comfort care that combines the medical expertise needed for complex symptom management with the compassionate, dignity-focused philosophy of hospice care.

Philosophy of Care: Unlike traditional hospital care that focuses on cure and recovery, inpatient hospice care maintains the hospice philosophy of comfort, dignity, and quality of life. The goal is not to treat the underlying disease but to manage symptoms and provide the best possible comfort.

Interdisciplinary Team Approach: Inpatient hospice care involves a complete team of professionals including physicians, nurses, social workers, chaplains, and other specialists all working together to address not just physical symptoms but also emotional, spiritual, and social needs.

Family-Centered Care: Even in an inpatient setting, hospice care remains family-centered. Families are encouraged to be present, participate in care decisions, and create meaningful moments together. Visiting hours are typically unrestricted, and accommodations are often made for family members who want to stay overnight.

Comfort-Focused Environment: Inpatient hospice facilities are designed to be as homelike as possible, with comfortable furnishings, space for family gatherings, and attention to creating a peaceful, healing environment rather than a clinical medical setting.

Holistic Support: Beyond medical care, inpatient hospice provides emotional support, spiritual care, and assistance with practical matters. This comprehensive approach recognizes that comfort involves more than just physical symptom management.

What To Expect in a Hospice Care or Assisted Living Facility

When your loved one transitions to inpatient hospice care, knowing what to expect can help ease anxiety and allow you to focus on spending meaningful time together.

Admission Process: The admission process is typically streamlined and focused on immediate comfort needs. The hospice team will have already coordinated with the facility, so much of the paperwork and logistics are handled in advance. Upon arrival, the primary focus is on making your loved one comfortable and assessing their current symptoms.

Room Environment: Rooms in hospice facilities are designed to be comfortable and homelike rather than clinical. You can typically bring personal items, photos, and favorite belongings to make the space feel more familiar and comforting.

Daily Routine: The daily routine in inpatient hospice is flexible and patient-centered. Meals, medications, and activities are scheduled around your loved one’s needs and preferences rather than rigid institutional schedules. Sleep and rest are prioritized, and activities are optional based on how your loved one is feeling.

Family Involvement: Families are welcome and encouraged to be as involved as they wish. Many facilities have no restrictions on visiting hours, and family members can often stay overnight. Common areas are available for family gatherings, and some facilities have kitchens where families can prepare familiar foods.

Care Team Interactions: You’ll interact regularly with nurses, physicians, social workers, and other team members. Communication is frequent and transparent, with regular updates about your loved one’s condition and comfort status. The team will involve you in care decisions and respect your family’s wishes and values.

Quiet and Peaceful Atmosphere: Inpatient hospice facilities maintain a quiet, peaceful environment that promotes rest and comfort. This is quite different from the busy, sometimes chaotic atmosphere of a hospital.

How Long Can a Patient Stay in Inpatient Hospice?

The length of stay in inpatient hospice care varies greatly depending on individual circumstances, but it’s important to understand that this level of care is designed to be temporary and focused on specific goals.

Crisis Stabilization: Many inpatient hospice stays are relatively short, lasting from a few days to a week or two, as the primary goal is to stabilize acute symptoms and either return the patient to a lower level of care or provide comfort during the final days of life.

Individual Variation: Some patients may need inpatient care for only a day or two to adjust medications and get symptoms under control, while others may require weeks of intensive support. The length of stay depends on the complexity of symptoms, response to treatment, and family circumstances.

Ongoing Assessment: The hospice team continuously assesses whether inpatient care remains necessary. If symptoms become manageable, the team will work with the family to plan for discharge to home or another appropriate setting. If symptoms remain complex, inpatient care may continue as long as medically necessary.

End-of-Life Care: For some patients, inpatient hospice care becomes the final setting where they spend their last days or weeks. In these cases, the focus shifts to providing the most comfortable and dignified end-of-life experience possible, with family support and presence prioritized.

No Arbitrary Limits: Unlike some medical settings, hospice care doesn’t have arbitrary limits on length of stay. As long as inpatient care is medically necessary and appropriate, insurance typically covers the stay. The decision about length of stay is based on medical need and family circumstances rather than financial considerations.

Services Provided by Inpatient Hospice Care

Inpatient hospice care provides comprehensive services designed to address every aspect of comfort and support during this challenging time.

Medical Services: Round-the-clock nursing care ensures that your loved one’s symptoms are monitored and managed continuously. Physicians are available for consultation and to make medication adjustments as needed. Specialized equipment and supplies are provided as necessary for comfort and symptom management.

Pain and Symptom Management: This is often the primary focus of inpatient hospice care. The team has expertise in managing complex pain, breathing difficulties, nausea, anxiety, and other symptoms that may be challenging to control in other settings. Medications can be adjusted frequently and administered through various routes to maximize comfort.

Emotional and Spiritual Support: Social workers provide counseling and support for both patients and families, helping to address fears, concerns, and emotional needs. Chaplains or spiritual counselors are available to provide spiritual support that honors your family’s beliefs and values.

Family Support Services: The team provides guidance and support for family members, helping them understand what to expect and how to best support their loved one. This includes assistance with difficult decisions, communication with other family members, and preparation for what lies ahead.

Bereavement Support: Support for family members extends beyond the patient’s death, with grief counseling and bereavement services available for up to a year after loss.

Coordination of Care: The inpatient team coordinates with your home hospice team, primary care physicians, and other healthcare providers to ensure continuity of care and communication about your loved one’s condition and preferences.

How to Apply for Inpatient Hospice Care

The process of accessing inpatient hospice care involves several steps, but your hospice team will guide you through each one to ensure a smooth transition.

Assessment by Hospice Team: The process typically begins when your home hospice nurse or physician identifies that symptoms are becoming too complex to manage at home. They will conduct a thorough assessment of your loved one’s condition and discuss the possibility of inpatient care with your family.

Physician Evaluation: The hospice physician will evaluate your loved one’s condition to determine if inpatient care is medically necessary. This evaluation may be done in person or through consultation with the nursing team, depending on the urgency of the situation.

Insurance Authorization: The hospice team will handle the insurance authorization process, working with Medicare, Medicaid, or private insurance to ensure coverage for inpatient care. This process is typically expedited when symptoms are acute.

Facility Coordination: Once the need for inpatient care is established, the hospice team will coordinate with available facilities to find an appropriate placement. They will consider factors like location, family preferences, and specific medical needs.

Admission Planning: The team will work with you to plan the admission, including transportation arrangements, what to bring, and what to expect upon arrival. They will also coordinate with family members to ensure everyone is informed about the transition.

Ongoing Communication: Throughout the process, the hospice team maintains communication with your family, providing updates about arrangements and answering any questions or concerns you may have.

What’s The Difference Between Outpatient Hospice Care and Inpatient Hospice Care?

Understanding the differences between outpatient and inpatient hospice care can help you better understand when each level of care is appropriate and what to expect from each.

Location and Setting: Outpatient hospice care is provided in your loved one’s home, assisted living facility, or skilled nursing facility – essentially, wherever they call home. Inpatient hospice care takes place in a specialized facility designed for intensive hospice care.

Level of Medical Supervision: Outpatient care involves intermittent visits from hospice team members, with family members providing much of the day-to-day care between visits. Inpatient care provides continuous professional nursing supervision and immediate access to medical interventions when needed.

Symptom Complexity: Outpatient care is appropriate for stable symptoms that can be managed with regular monitoring and family support. Inpatient care is reserved for complex, acute symptoms that require frequent assessment and intervention.

Family Involvement: In outpatient care, families are the primary caregivers with professional support. In inpatient care, professionals provide the primary care while families focus on emotional support and spending quality time together.

Cost and Coverage: Both levels of care are covered by Medicare and most insurance plans, but the daily cost of inpatient care is higher due to the intensive level of services provided.

Duration: Outpatient care can continue for months or even years, depending on the patient’s condition. Inpatient care is typically short-term and focused on stabilizing specific symptoms or providing end-of-life comfort.

Goals of Care: Both levels of care focus on comfort and quality of life, but outpatient care emphasizes maintaining normalcy and familiar surroundings, while inpatient care prioritizes intensive symptom management and medical stability.

Family Support: Both levels provide family support, but inpatient care often includes more intensive family counseling and support services due to the acute nature of the situation.

At Serenity Palliative & Hospice Care, we’re committed to providing the right level of care at the right time for every family we serve. Our experienced team is available 24/7 to assess changing needs and ensure your loved one receives the most appropriate care, whether that’s in the comfort of home or in a specialized inpatient facility. If you have questions about hospice care levels or need to discuss your loved one’s changing needs, please don’t hesitate to contact our compassionate team. We’re here to support you through every step of this journey.