Hospice General Inpatient Level of Care
What is Hospice Inpatient Care?
Hospice general inpatient (GIP) care is short term care provided through a contract agreement with an appropriately licensed and Medicare–certified hospital or long-term care facility. GIP can also be provided by a hospice program in a hospice–inpatient facility to provide pain control and symptom management that cannot be accomplished in the patient’s home setting, which may be a nursing home, assisted living or personal residence.
Who qualifies for hospice general inpatient (GIP) level of care?
GIP level of care is always short term, typically for less than two weeks. Patients are evaluated on a case-by-case basis and generally may be admitted for pain or symptom that is uncontrolled despite aggressive treatment efforts or when death is imminent and symptoms are uncontrolled. Patients may also be admitted when the physician and hospice interdisciplinary team (IDT) believes the patient needs pain and symptom management that cannot feasibly be provided in other settings. Some examples of uncontrolled symptoms include but are not limited to:
- Pain requiring aggressive & frequent medication titration;
- Pain/symptom management requiring frequent medication regimen adjustment;
- Dyspnea or respiratory distress that is uncontrolled in an outpatient setting;
- Uncontrolled nausea/vomiting;
- Severe agitation/delirium;
- Acute anxiety or depression secondary to the end- stage disease process;
- Evaluation of hallucinations, delusions, paranoia, agitation with combativeness;
- Other complicated care for stable or unstable medical conditions: frequent suctioning, dehydration, recurrent seizures, rapidly accumulating ascites or rapid fluid retention causing pain;
- To facilitate discontinuation of ineffective therapies;
- A patient whose family is unwilling to permit the needed care in the home.
The attending physician will continue to round with the patient per hospital guidelines.
What steps are taken to transition to general inpatient care?
When a patient meets criteria for general inpatient level of care, a physician writes an order for “inpatient hospice care.” Consent for inpatient care must be provided by the patient or representative. If the patient is already hospitalized, the patient is discharged from acute care and admitted as an inpatient hospice patient. The hospice maintains professional responsibility for its patient and works with the facility to develop the plan of care. Interventions are palliative focused, therefore, aggressive, diagnostic or life prolonging treatment is not appropriate for general inpatient hospice care. The hospice H&P (history and physical) and physician orders must be completed and signed by the physician after which hospice personnel will conduct their initial assessments (nursing, social services and chaplain). The nurses and staff on the unit continue to provide the care in accordance with hospice’s plan of care.
All locations have a medical director and /or physician advisors who work as part of the hospice team.
A hospice nurse is the member of the hospice team who ensures the patient/representative signs a consent for inpatient hospice care.