Levels of Care

Nursing Knowledge

Levels of Care

Nursing levels of care are a structured approach to patient care. These levels, ranging from preventative and primary care to intensive and palliative care, dictate the complexity and resources required for patient management and guide nurse staffing, skill set requirements, and care strategies. They ensure that patients receive appropriate supervision and interventions corresponding to their health status.
Last updated: December 4, 2023


Nursing in context: get an overview of the relevant concepts and terms in the healthcare system that influence daily nursing practice.

Table of contents

What are levels of care? 

Every individual requires different care depending upon their health problem. Levels of care in nursing refer to these varying degrees of attention and support patients need based on their current health status. These levels are used by healthcare providers to organize and allocate resources effectively. 

The 4 general levels of care are: 

  1. Primary care
  2. Secondary care
  3. Tertiary care
  4. Quaternary care

Additional forms are long-term care and palliative care. The majority of the time patients may typically receive primary or secondary care. It is only when patients have a severe injury, condition, or disease that they will be moved to the higher levels. 

Primary care 

For most patients, a primary care clinician will be their first point of contact in the health system. Primary care clinicians can be doctors, dentists, nurses, allied health professionals, or pharmacists, who may provide care in general practices, or health centers. Prevention and health education are parts of primary care. 

Secondary care 

Secondary care encompasses health services provided by medical specialists and other healthcare professionals who do not have the first contact with patients, such as cardiologists, rheumatologists, or urologists, with care usually being delivered in a hospital after referral by the primary care provider. Exceptions to this rule are healthcare specialists such as psychiatrists or physiotherapists, who often don’t provide their ongoing services in a hospital. 

Tertiary care 

Examples of tertiary care services include cardiac surgery, cancer treatment, or plastic surgery: treatments for patients requiring a higher level of care in a hospital, often provided by highly specialized physicians. 

Quaternary care 

Quaternary care is a more complex level of tertiary care, including uncommon, highly specialized, and experimental treatments and procedures. It is usually only offered in a limited number of health care centers. 

Levels of care in different settings 

The concept of levels of care can be used in and applied to various specific healthcare settings to classify the types and intensity of care within these contexts. 

Levels of care in hospital

Within a hospital, the different units roughly reflect the care levels provided:

  • Emergency care: life-threatening conditions requiring rapid intervention
  • ICU: critically ill patients
  • Acute care: severe but not life-threatening
  • Surgical care: care around surgical procedures
  • General ward care: moderate conditions
  • Palliative care: focus on quality of life and symptom relief, includes end-of-life care

Assisted living levels of care

Assisted living facilities provide a spectrum of care to meet the diverse needs of residents, particularly older adults, who may require assistance with daily activities and medical care. Here are common levels of care in assisted living: 

  1. Basic/level 1: most independent, minimal assistance with ADLs 
  2. Intermediate/level 2: more consistent assistance needed with ADLs (e.g., bathing, dressing) 
  3. Advanced/level 3: significant help needed with mobility, personal hygiene, close monitoring of health conditions, medications 
  4. Respite care: provides caregivers a break by having patient stay in facility for a short period of time
  5. Palliative care: focus on comfort and quality of life, multidisciplinary approach 

Memory care is often seen as a separate category. Patients with dementia receive services from all levels, but this type of care is a secure environment that helps prevent wandering and with staff having specific training for dementia care. 

Levels of care for older adults (elderly)

Levels of care in the context of geriatric nursing orient themselves mainly by how independent the clients still are in personal activities of daily living:

  1. Preventive or primary care: focus on maintaining health and wellness, managing chronic illnesses, and screening
  2. Home health care: home health care nurses providing assistance with ADLs and services of wound care and medication management in the patients’ homes; can prevent hospital admissions or allow for early discharge
  3. Assisted living: not exclusively a nursing level, but helps residents with health monitoring, medication, and cooperation with healthcare providers → no intensive medical care needed but help needed with ADLs
  4. Skilled nursing facilities: higher levels of medical attention and round-the-clock supervision needed; comprehensive nursing care 
  5. Memory care units: specialized care units for patients with dementia 
  6. Acute geriatric care: specialized geriatric wards in hospitals for serious health issues
  7. Palliative care: specialized care with patients who have serious illness (cancer, heart failure)

Levels of care: mental health

Levels of care in mental health form a scale from prevention to outpatient or inpatient care, depending on acuity and severity of patients’ needs: 

  • Prevention: includes community programs, education, early identification of individuals at risk
  • Outpatient care: therapy sessions, consultations, medication management
    • Intensive outpatient programs or partial hospitalization programs: not 24-hour care, but more structured and intensive than standard outpatient treatment
  • Inpatient care: treatment in secure hospital setting 
  • Residential care: long-term care for patients with chronic illness who need ongoing support 
  • Crisis services: immediate care during mental health crises (e.g., suicidal behavior, hotline support, emergency room treatment) 

Hospice levels of care

Hospice care focuses on the comfort and quality of life for patients who are facing a life-limiting illness. It’s more about caring than curing, providing humane and compassionate care for people in the last phases of an incurable disease. In the United States, hospice care settings generally offer four levels of care to meet the varying needs of patients and their families, as defined by Medicare:

  1. Routine home care: most common; services typically not round-the-clock
  2. Continuous home care: eight or more hours a day; short-term 
  3. Inpatient respite care: providing caregivers a break by caring for patient in a facility; for up to 5 days at a time
  4. General inpatient care: for symptoms too severe to be cared for at home or in current facility; patient moved to facility for round-the-clock care 

NICU levels of care

The levels of care in a newborn intensive care unit are: 

  1. Level 1 (well newborn nursery): health newborns, equipped to resuscitate if necessary; newborns with difficulties are stabilized here before being transferred
  2. Level 2 (special care nursery): infants born at gestational age > 32 weeks, or recovering from more severe conditions; moderate illness 
  3. Level 3 (NICU): born at gestational age < 32 weeks or critical illness; wide variety of specialists 24/7
  4. Level 4 (regional NICU): highest level of prenatal care, additional capabilities for surgery for congenital/acquired conditions; all pediatric medical subspecialties available

ASAM levels of care 

The ASAM levels of care are a classification system designed for addiction treatment, provided by the American Society of Addiction Medicine (ASAM). 

  1. Level 0.5: early intervention 
    • Not formal treatment
    • Educational program for those at risk 
  2. Level 1: outpatient 
    • Less than 9 hours of service per week for adults 
    • Recovery or motivational enhancement 
  3. Level 2: intensive outpatient
    • 2.1: intensive outpatient
    • 2.5: partial hospitalization
    • Organized service providing => 9 hours of structured programming per week 
  4. Level 3: residential
    • 24-hour care in a treatment facility
    • Sublevels from 3.1 (low-intensity) to high-intensity, medically monitored (3.7)
  5. Level 4: medically managed intensive inpatient
    • 24-hour nursing care with daily involvement of a physician
    • For severe, unstable problems  

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