Does Medicare Cover 24-Hour In-Home Hospice Care?

As families make end of life decisions, one of the most critical ones is “will Medicare pay for 24 hours of in home care when we are in this crisis?” Yes, but only during certain clinical crisis periods when a Medicare hospice level is entitled to be called "continuous home care. The hospice benefit of Medicare has four phases of care that step up as a patient's condition worsens. The most common type of home care is routine home care, increasing to about 99% of all hospice days across the country. About 11% of hospice patients receive continuous home care, which is 8-24 hours per day of nursing care during a short window of time. Inpatient respite can be provided in a facility for up to 5 consecutive days to give family caregivers a respite. General inpatient care is a higher level of symptom management provided in a hospital setting, when home care is not adequate. The Centers for Medicare & Medicaid Services (CMS) established eligibility criteria and uses for each level.

This pamphlet covers the four types of hospice care provided under Medicare or in a person's home, the availability of 24-hour in-home care, eligibility information, and what families can expect. Data provided by Medicare.gov, CMS, and The National Hospice and Palliative Care Organization. 

The four levels of Medicare hospice care

The Medicare hospice benefit operates through four distinct care levels, with patients moving between levels as their needs change. Understanding each level helps families know what care is available and when.

Routine home care (RHC) is the most common hospice service, provided wherever the patient lives. The patient's home can be a private residence, an assisted living facility, a skilled nursing facility, or a long-term care facility. The hospice interdisciplinary team (physician, nurses, social workers, chaplains, hospice aides, and others) conducts regular visits based on the care plan, typically several times per week. The team is on call 24/7 for emergencies, though they don't provide continuous bedside care during routine periods.

Continuous home care (CHC) is the level that provides up to 24-hour nursing care at home. CHC is provided only during brief periods of clinical crisis when intensive nursing care is needed to keep the patient at home and avoid hospitalization. The level requires at least 8 hours of direct patient care in a 24-hour period, with the majority (more than 50%) being skilled nursing care from RNs, LPNs, or LVNs. Hospice aides and homemaker services can supplement nursing care.

Inpatient respite care is designed to give family caregivers a break, not for medical crisis management. Patients receive care in a Medicare-approved facility (hospice inpatient unit, hospital, or nursing home) for up to 5 consecutive days at a time. Respite care includes room and board. Caregivers often schedule respite to travel, attend important events, or manage their own health needs.

General inpatient care (GIP) addresses symptoms that can't be managed at home. Patients receive care in a hospital, hospice inpatient unit, or nursing facility with 24-hour registered nurse availability. GIP is appropriate for uncontrolled pain, intractable nausea or vomiting, respiratory distress, severe wounds requiring intensive treatment, or other acute symptoms requiring intensive intervention.

For broader hospice coverage details, see our hospice Medicare guide.

When continuous home care (24-hour) is available

Continuous home care is a specific type of care for short durations of clinical crisis. The goal is to give intensive nursing care to control acute symptoms and prevent hospitalisation and return the patient to normal home care when the crisis passes.

Other factors associated with a need for continuous home care are uncontrolled pain not responsive to hospice interventions, severe respiratory difficulty (such as air hunger or labored breathing), unexpected or persistent nausea and vomiting not corrected with regular medications, refractory seizures (new onset, or those not controlled with regular medication) and/or adjustment of medications that requires close nursing supervision.

The patient and family desires to stay in their home versus going to hospital or to an inpatient hospice facility. CHC must have nursing care as the primary treatment (more than 50% skilled nursing care by RN, LPN or LVN). Caring tasks performed by hospice aides that do not require professional medical skills such as bathing, ambulating or helping with meals are also available to supplement nursing care.

CHC is not about caregiver fatigue with non-skilled care needs (that's respite care), about placement difficulties, or it's not a long-term continuous care nursing for a patient who is declining with no crisis events. Once the crisis is over, the patient returns to regular home care.

The highest level of hospice services is CHC, the most staff-intensive and costly level. Many hospice agencies have few hospice certified nurses and they are hard to find in the community and to schedule on short notice for intensive home based care. Emergency supplementation (when CHC is necessary) is sometimes provided through a contract with a staffing agency.

Inpatient respite care: caregiver relief

Inpatient respite care can help relieve the primary caregiver when they need a break (not when the patient is in crisis) and helps the patient through up to 5 days of respite per admission in a Medicare-approved facility. While there is no specific limit on respite admissions per year, there is Medicare auditing for appropriate use.

Inpatient hospice care is offered at a hospice inpatient care facility, hospital or nursing home that has a contract with the hospice agency. The facility offers around-the-clock nursing and supportive services. Respite patients stay in a room with room and board paid for by Medicare, this is a huge advantage (usually not provided for patients who are receiving care at home in their own home).

Respite care has a 5 percent coinsurance for each day of care, up to the annual inpatient hospital deductible ($1,736 in 2026). The out of pocket expense for most respite stays of 5 days or less is not great.

For a patient who resides in a nursing facility, respite care is not available (because the patient already receives 24 hour care in a nursing home). Respite is specifically for the patient living at home and daily care is given by a family caregiver. 

General inpatient care: when home isn't enough

General inpatient care (GIP) is for patients whose symptoms can't be managed at home despite intensive interventions. GIP is offered in a hospital, hospice inpatient unit or a nursing facility that has 24-hour RN coverage.

GIP is distinct from CHC, in that it takes place in a different setting. CHC continues to care for the patient at home with frequent visits, GIP transfers the patient to a facility for intensive medical management. This is determined by the symptoms that need, patient and family preferences, and facility resources.

GIP triggers are uncontrolled pain necessitating frequent medication changes using intravenous routes or epidural management, and severe respiratory distress that requires changes in oxygen therapy or specific intervention, or complex wound care that requires multiple daily interventions, or intractable nausea or vomiting that requires intravenous medication and frequent assessment, and severe agitation or terminal restlessness that requires close monitoring.

The patient doesn't pay coinsurance for GIP days (Medicare pays the full hospice rate). Once symptoms have reached a steady state, the hospice team moves the patient back to a place of regular home care or other suitable care.

See our duration guide for how long Medicare will cover hospice. 

Medicare hospice eligibility requirements

To receive any level of Medicare hospice care, patients must meet specific eligibility criteria. The attending physician (if there is one) and the hospice physician must both certify that the patient has a terminal illness with a medical prognosis of 6 months or less if the illness runs its normal course. The patient must sign an election statement choosing hospice care and waiving Medicare payments for curative treatment of the terminal illness and related conditions.

The patient must have Medicare Part A. Part B isn't required for hospice, though most beneficiaries have both. Medicare Advantage plan members can elect hospice care under Original Medicare while keeping their Medicare Advantage plan for non-hospice care.

The 6-month prognosis is a clinical estimate, not a hard deadline. Many hospice patients live longer than initially expected. Hospice care can continue as long as the physician recertifies the terminal illness at required intervals (90 days for first two benefit periods, then every 60 days).

For more on hospice duration and recertification, see our hospice duration guide.