Levels of Hospice Care: What Every Hospice CNA Needs to Know

As a hospice CNA, you will have some liberty when you are job hunting in choosing the work environment that best suits your abilities and level of comfort. The way that the hospice care system is designed, people seeking services typically also have a choice concerning where they will receive the care and services from hospice. There are four primary level of hospice care that have been clearly defined partly due to the changes in benefits offered under the Medicare program, particularly Part A, and its newly defined limitations that do not cover hospitalization charges for hospice patients. Here, we will discuss these four levels, which fall under the categorization of routine home care, continuous home care, general inpatient care, and respite care. Keep in mind, that the level of services required for a patient may change at any time as their needs change, and you will encounter even more rapid changes in status with patients receiving palliative care.

Routine Home Care

Routine home care is the most basic level of care one can receive under the hospice benefit; however, patients that reside in a nursing home facility can also be considered under this category, as that is their home. During the course of this type of care, there-

 are a number of things that occur involving all parts of the interdisciplinary team, and many of the procedures are carried by out by hospice and palliative CNA team members. A registered nurse will typically visit the residents between one and three times per week based on each patient’s needs, but can occur more often as necessary.

Physicians rarely make house calls to patients, as they have generally already met with the patient prior to their enrollment in hospice care; however, nurses stay in constant contact with the overseeing physician concerning the patient’s status. Counseling and social work services are dispatched as needed to the patient’s home or care facility to address pastoral, bereavement, and financial services.

Continuous Home Care

As a hospice CNA, many tasks will ultimately fall upon your shoulders, as you will encounter patients more often than they will encounter any other medical caregiver, especially within the home. Expect to visit patients at least two to three times per week to assist with grooming, bed linen changes, and light housekeeping in addition documenting the patient’s status concerning pain, medication availability, and emotional standing. You will also behelping family members and patients become familiar with any medical equipment ordered, and you may need to show them how it operates after delivery to the home. You will also need to ensure that all equipment works during your visits, and take special care with vital equipment such as oxygen tanks, nebulizers, and other essentials that contribute to patient comfort. Home care does have its challenges, but it also gives you a chance to bond with patients and families on a level that other medical providers do not have the opportunity to.

When a patient develops emotional or physical symptoms that are not easy to manage under routine care, the next option is continuous home care. Some examples of the symptoms that call for continuous care are increased levels in pain, new symptoms, breathing problems, nausea and vomiting, emotional troubles, or a breakdown within the primary caregiver support system. This level of hospice provides additional care within the patient’s home environment, and the need for this care is reevaluated every 24 hours. Depending on the status of the charge, nurses or CNAs will remain in the residence with the patient for a minimum of 8 hours per day up to round the clock care. Because CNAs cannot administer medications, you would likely be filling in during the hours when a family member or nurse authorized to administer medication is not available. Of course, this depends on whether the patient is in a private home or a nursing home. When working a case requiring continuous care you will need to bring a lunch to work and something to occupy the down hours such as a book, puzzle, or personal project.

General Inpatient Care

Some patients have symptoms so severe that inpatient care is the most reasonable solution for both the charge and the caregivers. Inpatient care is anexcellent way to ensure that the patient has continuous access to a full medical staff armed to handle any problem that may arise at any time. Essentially, the approach to caring for the patient will not differ from any other level of hospice care, as only the patient’s location is changed. Facilities that offer inpatient hospice services include:

• Hospitals – Space may be leased to hospice providers where patients can receive both the benefits of a full medical facility under the supplemetal assistance of the hospice provider’s staff.

• Free Standing Facilities – These are owned and operated by the hospice company and staffed by medical providers under the employ of the institution.

• Long Term Care Facilities – Similar to the agreement made with hospitals, hospice providers may lease space and provide care to their own charges within this environment.

Respite Care

This particular level of care is actually designed to be more for families that care for the patient on a continuous basis within the home than for the actual patient. Caring for an ill person at home is a 24 hour a day job, and families can grow weary over time, especially if their loved one has been ill for an extended period. Respite care is a temporary placement of the patient into inpatient care to allow the family a much needed break, or respite. These services are limited to five consecutive days, and then the patient is discharged back to their home.

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