When Is Hospice Continuous Care Necessary?

The continuous care Center for Medicare and Medicaid (CMS) Services regulations state that hospices may only provide this kind of care if it is required to keep a person at home. It must be a period of crisis — a time when a patient requires constant care, primarily nursing care, to relieve or manage acute medical symptoms.

As per the National Hospice and Palliative Care Organization’s definition, continuous care includes predominately nursing care, covered for at least 8 hours and up to 24 hours, beginning and ending at midnight. Either homemakers or hospice level of care services (or both) may be covered on a 24-hour continuous basis during periods of crisis, but the care must be predominantly nursing care.

Who Qualifies for Continuous Home Care?

Hospices can give this form of care at the patient’s own home or in a long-term care facility. In a moment of crisis, continuous hospice care is meant to ease uncontrollable symptoms swiftly.

These uncontrollable signs and symptoms include:

• Intense pain
• Bleeding
• Acute respiratory difficulty
• Nausea and vomiting that won’t stop
• Restlessness at the end of life

The CMS standards state that if a hospice patient is actively failing, but their symptoms are under control, they do not qualify for ongoing hospice treatment. Continuous care for hospice patients is also unavailable for patients in an inpatient hospice unit, a hospital, or a skilled nursing facility.

When Is Continuous Home Care Inappropriate?

According to the CMS, continuous home care may be provided only during a crisis to manage pain and symptoms. Continuous home care is NOT appropriate:

• For a patient who is imminently dying with no acute skilled pain or symptom management needs
• For caregiver failure with no immediate need for professional pain or symptom treatment
• When continuous home care is not intended to be used as respite care
• In the absence of a necessity for professional assistance, for safety concerns (for example, falls, roaming, etc.)
• As an alternative to hiring professional caretakers or being placed in a different care setting

With the preceding in mind, if a patient’s caregiver has been providing a competent level of care for the patient and the caregiver is unwilling or unable to continue providing care, a period of crisis may ensue since the patient may require a nurse’s abilities to replace the caregiver’s services.

Where Can Continuous Home Care Be Provided?

CHC can be delivered at the patient’s residence, for example:

• A private residence
• An Assisted Living Facility
• A long-term care facility or non-skilled nursing facility (if the patient is not receiving a skilled level of care, i.e., Medicare Part A skilled benefit)
  • Keep in mind how nursing homes are certified in your state since this can affect where the care codes on the hospice claim form are located.