Hospice Level 2: Continuous Home Care

There are patients who may start out receiving hospice care at home, and end up requiring more than just routine hospice care. Unfortunately, some patients may have such severe symptoms, pain, or medical conditions that they warrant extended periods of in-home nursing care.

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In such cases, these patients need longer monitoring and dedicated medical treatment via level two of hospice care. Known as continuous home care (CHC), this level of hospice care is only for brief periods of crisis and helps to keep a patient at home for as long as possible.

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What Happens During Continuous Home Care?

During continuous home care, hospice provides at least eight hours of in-home homemaker, nursing, or hospice aide care during a 24-hour day. At least half of those provided services must be nursing care from a registered nurse (RN), licensed practical nurse (LPN), or licensed vocational nurse (LVN). However, the name is a bit misleading, as the care hours don’t need to be continuous. For example, a nurse could come for five hours in the morning and then a hospice aide for three hours in the evening.

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When nursing, hospice aide, and/or homemaker services are provided for fewer than eight hours in a 24-hour day, Medicare classifies the day as routine home care. Additionally, if a nurse spends less than four hours per day as part of those services, Medicare classifies that day as routine home care.

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When a total of eight hours has passed, and at least half of those hours of care are from a nurse, Medicare classifies the day as continuous home care.

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Patients continue to receive all of their typical hospice care services on top of the increased hours of nursing care. Like with routine home care, these services include visits with physical therapists, hospice volunteers, bereavement counselors, nutrition counselors, and other hospice team members.

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Which Patients Need Continuous Home Care?

Patients may require continuous home care for one of two reasons. Sometimes, a caregiver is unable to continue providing the highly skilled level of care they have been so far. When skilled caregivers step away from their role, a hospice team may decide a nurse is needed to replace them. The physician in charge of a hospice care plan can make this determination.

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Patients might also need continuous home care when they experience a medical crisis or escalating pain or symptoms. For example, perhaps a hospice patient experiences new onset seizures. Hospice can then provide a hospice aide for monitoring and a nurse for skilled care. So long as those services are provided at a minimum of eight hours a day, with the majority being nursing services, it would be considered CHC.

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Continuous Home Care Helps With Pain and Symptom Management

As our bodies evolve, so does our care. When getting closer to death, our delicate constitutions can get aggravated by a weakened immune system or a sudden increase in pain. When this happens, patients can no longer rely on basic levels of care and symptom management offered from hospice, but they still wish to stay at home. Continuous Home Care meets this need, with additional care and monitoring for those moments when the pain might be too much.

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There is no shame in getting more care, as hospice works to meet all patients where their needs are.

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In-home care is ideal but not always possible. General inpatient hospice care can meet almost any patient needs when a crisis emerges.

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