Continuous Care Hospice – Goal and Regulations
While many home hospice patients need little more than weekly nursing visits, some experience crises in which their symptoms — seizures, breathing troubles, pain, and more — result up in ways that can’t be managed without sustained attention. To control such situations, hospices are a great solution since they’re required by Medicare to provide continuous care services. They offer continuous care hospice or around the clock hospice care for patients in their homes.
What is Hospice Continuous Care?
Continuous or 24-hour hospice care is similar to inpatient hospice care, except the patient remains in their private residency instead of being transferred to an inpatient care unit. This advanced level of care for hospice patients is provided only during periods of “crisis” to maintain a patient in their home. It’s necessary when symptoms aren’t well controlled, and the patient needs sustained nursing care to attain symptom control.
Continuous home care hospice can be offered in
- Home setting;
- An assisted living facility;
- A hospice facility if the patient isn’t receiving an inpatient level of care;
- A long-term care facility where the patient isn’t receiving a skilled level of care.
Continuous home care hospice can’t be provided in
- Inpatient hospice facility or Inpatient hospital;
- Long-term care hospital where skilled care is provided;
- A skilled nursing facility;
- Inpatient psychiatric facility.
When is Continuous Care Hospice Appropriate?
If a patient develops emotional or physical symptoms that can’t be adequately managed with standard hospice care, continuous care may be a solution. It delivers an advanced level of care in the patient’s home environment. A home health aide or hospice nurse will be present in the patient’s home environment for up to 24 hours per day to administer medications, provide care, treatments, and support until the symptoms are under control.
Examples of patients who may qualify include:
- A person with acute respiratory distress, who’s having trouble breathing while at home;
- A patient who has fallen and bleeding frequently or uncontrollably;
- Someone who has constant vomiting and nausea;
- Patients that are leaving the hospital but still require a nurse to consistently check in on them until they’re stable in their home;
- When a patient has end-stage agitation and needs consistent care to keep them comfortable and calm.
Can Any Hospice Patient Receive Continuous Care?
Not every patient on hospice care is eligible for continuous care. Again, an individual must be in an acute crisis condition to be able to receive 24-hour care. Many people believe hospice is an around the clock service, but that specific level of care is only available via continuous care.
What Types of Symptoms Require Continuous Care?
Hospice continuous care is intended to rapidly alleviate uncontrolled symptoms in a time of crisis. These symptoms are:
- Serious pain;
- Acute respiratory distress;
- Terminal restlessness or agitation;
- Unrelenting vomiting and nausea.
Note – If a hospice patient is actively declining, but their symptoms are under control, they don’t qualify for continuous care hospice under the CMS regulations.
Hospice Continuous Care Documentation
When it’s determined that a beneficiary meets the requirements for continuous care in hospice- proper documentation must be available to explain why these hospice services were reasonable/necessary and follow an established plan of nursing to meet specific hospice crisis care criteria.
When a type of care changes, the medical record must demonstrate the date, time, and reason the level of care is altered. You need to document the interventions and observations to support the need for each hour of continuous care billed.
The supportive documentation should clearly show the beneficiary’s condition warranting the interventions provided by the hospice staff at this advanced level of care. The documentation must then describe the beneficiary’s response to care.
Payment for continuous care will be paid based upon the total number of 15-minute increments, and with rounding to the next higher hour. Only direct patient care during the crisis may be billed.
The regulations state that the hospice unit must provide continuous care for 8 to 24 hours per day as long as the symptoms are seriously out of control. If hospice staff can get the symptoms controlled and the patient comfortable within eight hours – then they can stop the continuous care, and the patient’s status will be changed to routine hospice care. However, the hospice team must make an effort to control the symptoms at home.
Does Hospice Provide 24 Hour Care at Home?
As we said, care doesn’t need to be around the clock but must total 8 hours or more of care within the 24-hour. The care must be predominantly nursing care delivered by a registered nurse, licensed practical nurse, or licensed vocational nurse. Hospice aide or homemaker services may be provided to complement the nursing care. This means that at least 50% of the total care must be provided by a nurse.
All homemaker and nursing aide services must be counted into continuous care time. Hospices can’t count fewer aide hours than were actually provided to augment the percentage of nursing hours. When aide hours surpass the nursing hours, routine home care must be billed.
What Are the Main Levels of Hospice Care?
The CMS has determined four levels of hospice care. One patient may experience all 4 levels, perhaps in just seven days of hospice services. Another patient may experience one level of care throughout their hospice care. Each kind of care meets specific requirements, and every hospice patient is unique.
Every Medicare-certified hospice provider must include these levels of care:
- Routine home care – It’s the necessary level of hospice care provided in your home, nursing, or assisted living home. This type of care offers a team approach by hospice staff and your doctor to provide comfort at the end of life. It includes medical social services, volunteer visits, spiritual support, support groups, bereavement counseling, equipment, medication and all supplies related to patient’s hospice diagnosis;
- Continuous home care – This is when a nurse stays in your home for an extended time, if your loved one is feeling a medical crisis and severe symptoms, including shortness of breath or unrelieved pain. Still, during a medical emergency like this, your hospice nurse or physician may decide the inpatient care will be a better solution to address your loved one’s requirements;
- Inpatient Care – Sometimes, severe pain or other symptoms need an advanced type of hospice care that is more efficiently made during a short stay in an inpatient hospice unit. If your loved one requires to intensify, the hospice staff may recommend this form of hospice and relocating your loved one to the inpatient level. The mission of inpatient care is to administer severe pain and symptoms so that patient can return home to their family, and resume routine home care;
- Respite Care – The level of care is provided on an occasional basis and offers a planned, short-term break for unpaid family caregivers. It can only be provided at a Medicare-approved inpatient hospital, hospice facility, or skilled nursing facility that is capable enough to provide 24/7 nursing care should your loved one’s plan of care require around the clock care.
Continuous Care Hospice FAQs
Here are a few key hospice questions to ask when visiting with an accredited agency you’re considering for serving care for your loved one.
You’ll want that emergency staffing, especially as your loved one enters the final few days of life.
Perfectly, nurses should manage no more than 12 patients at a time, especially if they travel. They don’t see all patients daily.
Have an idea of what you and your loved one want and whether that is within the range of the hospice’s care.
Sometimes staying in a hospice facility is temporary and can be used to stabilize patients until they can return home.