What to Expect From Inpatient Care
When Symptoms Can't Be Managed at Home
Most of the time, hospice care is brought to the patient at home, since home is where most seriously ill people want to be: in familiar surroundings with familiar routines and familiar faces.
However, all hospices must offer inpatient care for pain control or acute or complex symptom management that cannot be managed in other settings. Inpatient care is provided in a facility—often a hospital, but also nursing facilities and free-standing hospice houses—that can provide round-the-clock clinical care.
Some patients may need the inpatient level of care to help them transition from hospitalized curative care to home hospice. Others receiving routine home care may have symptoms that become exacerbated. In either case, the patient usually receives inpatient care for a short period of time (3–5 days) until symptoms are under control, then returns home.
When Is Inpatient Hospice Care Appropriate?
Indications of the need for inpatient hospice care include:
- Sudden deterioration requiring intensive nursing intervention
- Uncontrolled pain
- Uncontrolled nausea and vomiting
- Pathological fractures
- Respiratory distress that becomes unmanageable
- Symptom relief via intravenous medications that require close monitoring
- Wound care requiring complex and/or frequent dressing changes that cannot be managed in the patient’s residence
- Severe agitated delirium, acute anxiety or depression secondary to the end-stage disease process requiring intensive intervention and not manageable in the home setting
- Uncontrolled seizures
- Minor procedures to aid in the comfort of the patient, such as removing fluid from the belly area (paracentesis) or placement of a permanent drain or tube.
The atmosphere in an inpatient hospice setting is markedly different from that of an acute care facility. It is calmer, its staff moving at a slower pace. They have time to talk with the patient, visit with the family, answer questions. Often the atmosphere is more homelike, too. All ages of family members and friends are welcome day and night, and arrangements may be made for overnight stays. But make no mistake: aggressive pain and symptom management is at work, with a goal of stabilizing the patient so they can return home.
Four Levels of Care
VITAS offers four broad types, or levels, of care as defined by the Medicare hospice benefit:
- Routine home care. This is how we provide hospice care most often: in patients’ homes, long-term care facilities and nursing homes.
- Continuous care (Intensive Comfort Care®). When medically necessary, acute symptom management is provided at home or in another facility by hospice staff in shifts of up to 24 hours/day so the patient can avoid hospitalization.
- Inpatient care. If a patient’s needs cannot be managed at home, VITAS inpatient hospice units and special arrangements at other local facilities provide hospice care around the clock until the patient can return home.
- Respite care. Limited to up to five consecutive days, respite care provides a brief “respite” for the patient’s primary caregiver by admitting the home care patient to an institutional setting without meeting the “inpatient” pain and symptom management criteria.