When someone you love needs hospice in Dallas County, timely answers bring peace of mind. This guide explains the four hospice levels of care, what each level includes, and how your family can move between levels without losing support. Here you will find how your team responds when needs change. You will also find practical signs that it may be time to adjust care, questions to ask your nurse, and how coverage generally works.

What Are the Four Hospice Levels of Care?

Medicare requires every certified hospice to provide four levels of care. These levels allow your team to increase help during a symptom crisis and reduce intensity when things stabilize.

• Routine Home Care (RHC): Ongoing visits at home or in a long-term care community to manage pain and symptoms, provide personal care, and support your family.
  
• Continuous Home Care (CHC): Short-term, around-the-clock nursing focused on managing a crisis at home, usually in blocks of at least 8 hours within a 24-hour period.
  
• General Inpatient Care (GIP): Short-term care in a hospital, hospice unit, or skilled nursing facility when symptoms cannot be managed at home.
  
• Inpatient Respite Care: Up to 5 consecutive days in a Medicare-certified facility to give family caregivers a needed break when the patient is otherwise stable.

These levels are defined by Medicare and are available from all Medicare-certified hospices. Coverage and criteria are standardized at the federal level. 

How the Levels Work in Real Life in Dallas County

Care needs change from week to week. A loved one may receive Routine Home Care most of the time, then shift briefly to Continuous Home Care during a pain or breathing crisis, or transfer to General Inpatient Care for complex symptom control. Once symptoms are controlled, care returns to Routine Home Care. The goal is comfort, safety, and dignity without unnecessary hospital trips. 

Signs to Increase the Level of Care

Use the list below to decide when to call your hospice nurse in Dallas County and discuss a higher level of support:

• Pain is severe or not responding to the current plan.
  
• Shortness of breath worsens, even at rest.
  
• Anxiety, agitation, or confusion increases.
  
• Nausea, vomiting, or secretions are hard to control.
  
• Multiple new wounds or a rapidly declining wound.
  
• Caregiver exhaustion that makes safe care at home difficult.

If any of these are present, ask whether CHC at home or a short GIP stay would help. For caregiver strain, consider Inpatient Respite Care to restore energy and reduce burnout. Clinical criteria guide decisions, and your hospice medical director makes the final determination with the team. 

What You Can Expect at Each Level

Routine Home Care

• Regular RN visits to adjust medications and monitor comfort
  
• Hospice aide support with bathing and personal care
  
• Access to social work and chaplain support for emotional and spiritual needs
  
• Necessary supplies and durable medical equipment (DME) such as a hospital bed, oxygen, or a wheelchair, delivered to your home
  
• On-call support 24/7 for urgent needs
  Learn more about these disciplines on our services pages: Nursing Services, Hospice Aides, Social Services, and DME.

Continuous Home Care

• Short-term, high-intensity nursing in your home to manage an acute crisis
  
• Goal is to control symptoms so your loved one can remain at home
  
• Once stabilized, care returns to Routine Home Care

General Inpatient Care

• Short-term transfer to a hospital, inpatient hospice unit, or skilled nursing facility
  
• Intensive nursing and medical oversight for symptoms that cannot be managed at home
  
• When symptoms improve, your loved one returns home or to a prior setting under Routine Home Care

Inpatient Respite Care

• Up to 5 days in a Medicare-certified facility
  
• Designed to give family caregivers rest while the patient continues to receive hospice services
  
• Returns to Routine Home Care after the short stay

All four levels are part of the Medicare hospice benefit and are available to eligible patients regardless of where they live within Dallas County. 

Local Considerations for Dallas County Families

• Care settings: Most care happens at home throughout Dallas, Irving, Garland, Grand Prairie, Mesquite, and surrounding communities. When GIP is needed, your team will coordinate with appropriate local facilities.
  
• Coordination: Your case manager and medical director work with your existing physicians to align the plan of care with your goals.
  
• Equipment and supplies: Hospital beds, oxygen, commodes, and wound-care supplies are typically arranged and delivered to your home. These items are part of the hospice plan of care when medically necessary.

Explore our Dallas County service area: Service Areas.

How Coverage Usually Works

Medicare pays hospices a daily rate for each day a patient is enrolled. The rate depends on the level of care for that day. This per-diem is intended to cover visits, on-call support, medications related to the terminal diagnosis, medical equipment, and supplies required by the plan of care. Co-pays and deductibles may apply for certain medications or respite stays. Private insurance and Medicaid have similar structures. Discuss specifics with your nurse or our admissions team before any transition.

Questions To Ask Your Nurse Before Changing Levels

• What is driving the need for a higher level of care right now?
  
• Can we try CHC at home first, or do symptoms require GIP?
  
• How will medications change during this level?
  
• Which facility options are available if we need inpatient care?
  
• How soon will we reassess and step back down when stable?
  
• What will transportation look like if we transfer to a facility?
  
• What should we pack and who will communicate updates to the family?

Bring these questions up during a visit or by calling the 24/7 line.

Caregiver Checklist for the Next 48 Hours

• Track symptoms using a simple log: pain scores, breathing, anxiety, nausea, and sleep.
  
• Note medication times and any missed doses.
  
• Keep the home pathway clear for a hospital bed, lift, or oxygen concentrator.
  
• Place the hospice medication box in one spot and discard expired or duplicate bottles.
  
• Identify who will be present overnight if CHC begins today.
  
• Confirm preferred hospital or facility choices in case GIP is needed.
  
• Write down three comfort goals for your loved one. Share these with the nurse.

When Does Care Level Change

It is common for care to adjust more than once in a week. Your team will keep you informed, update the plan of care, and make sure you understand medication changes. If your goals shift, tell your nurse right away. The plan can be revised to match what matters most to you.

How iServe Hospice Supports You Across All Levels

Your interdisciplinary team includes a medical director, nurse practitioner, registered nurses, hospice aides, social worker, chaplain, dietician, volunteers, and a case manager who coordinates everything for you. You can learn more about each discipline here: Hospice Care. If symptoms escalate, we can start CHC at home or arrange GIP, then step back down as soon as your loved one is comfortable.

Frequently asked questions

• Can my loved one receive hospice in assisted living or a nursing facility in Dallas County?
  Yes. Routine Home Care and Continuous Home Care can be provided in those settings. GIP and Respite occur in Medicare-certified facilities.
• Who decides when to change levels?
  The hospice medical director or physician member of the interdisciplinary group makes the determination based on clinical criteria and your loved one’s condition. Family input is part of that discussion.
• Will equipment like a hospital bed be provided?
  Yes, when medically necessary and included in the plan of care. Delivery and setup are arranged for you.
• Does hospice replace my loved one’s primary doctor?
  No. The hospice team coordinates with existing physicians and specialists to align care with your goals.

Consult About the Right Level of Care

Call our 24/7 team at (469) 480-1130. You can also request guidance or a same-day evaluation here. We support families across Dallas County and throughout Collin, Denton, Ellis, Kaufman, Rockwall, and Tarrant counties.