Continuous home care in hospice

What is continuous home care in hospice?

Continuous home care is one of the four levels of hospice care. Medicare allows it only during brief periods of crisis, and only as needed to keep the person at home (42 CFR 418.302). A period of crisis is a time when the person needs continuous care, mostly nursing care, to bring sudden or severe symptoms under control (42 CFR 418.204).

Most days on hospice are routine home care: scheduled visits and a nurse by phone. Continuous home care is the step up for a crisis, with hospice staff staying in the home for hours at a time instead of visiting.

When is continuous home care used?

When a symptom crisis needs skilled nursing for many hours, and the person can still be cared for where they live. For example:

• Pain that is not responding to the usual medicines
• Severe shortness of breath
• Nausea or vomiting that will not stop
• Severe agitation or restlessness
• A family caregiver who has been giving skilled, nurse-level care can no longer give it, so a nurse is needed to take over that care. Medicare's manual says this may bring on a period of crisis

The rules for continuous home care

Sources: 42 CFR 418.204(a) and 418.302, and the CMS Medicare Benefit Policy Manual, chapter 9, section 40.2.1.

Where can continuous home care happen?

Wherever the person lives: a house or apartment, a family member's home, an assisted living community or board-and-care home, or a nursing home where the person lives long-term. Medicare's manual says a long-term resident of a nursing home can receive it, but not during a short Medicare-covered skilled nursing (rehab) stay, in a hospital or in a hospice inpatient unit. In an inpatient setting the level is general inpatient care.

Beta Hospice provides continuous home care in all five counties we serve: San Bernardino, Riverside, Los Angeles, Orange and Ventura.

How continuous home care starts and ends

1. Step 1

   You call the hospice

   Call the hospice nurse line when symptoms are out of control. A hospice nurse answers the phone 24 hours a day, 7 days a week, and can visit when needed.

2. Step 2

   A nurse assesses

   The nurse comes to the home, treats the symptoms, and checks whether the crisis needs many hours of nursing care.

3. Step 3

   The team and the hospice doctor decide

   If the person meets Medicare's rules, the hospice orders continuous home care and schedules nurses and aides to stay. The team explains the plan to you.

4. Step 4

   The team keeps checking

   While continuous home care lasts, the team checks whether the crisis is still there and adjusts medicines and the plan.

5. Step 5

   Care steps back down

   When symptoms are under control, care returns to routine home care. If symptoms cannot be controlled at home, the team may arrange a short general inpatient stay. Some people die during a crisis at home. See when someone dies at home.

Who pays for continuous home care?

It is part of the hospice benefit. Medicare pays the hospice for each hour of continuous care. The cost-sharing Medicare lists for hospice is a copay of up to $5 per prescription for symptom medicines and 5% of the Medicare amount for inpatient respite care. There is no separate cost share for continuous home care itself; the prescription copay can still apply.

Medi-Cal covers the same level. In California a Medi-Cal managed care plan must not require prior authorization for continuous home care (DHCS All Plan Letter 25-008). For a Medicare Advantage member, Original Medicare pays the hospice. See paying for care.

What families do during continuous home care

Stay close if you can, and tell the nurse what you notice and what the person would want. The nurse gives the medicines and the hands-on symptom care, and teaches you what to watch for after the crisis passes. Make space near the bed for the nurse to work, and keep the medicine list and comfort kit where the nurse can find them. See the comfort kit.

Common questions about continuous home care

Related guides

The four levels of hospice care, inpatient hospice care, respite care, can you call 911 on hospice?, and, for clinicians, levels of care criteria.