Hospice care provides comfort and support for individuals nearing the end of life, focusing on symptom management and quality of life rather than cure. The Medicare Hospice Benefit mandates that all certified agencies must offer four distinct levels of care to meet varying patient needs. One of these intensive levels is Continuous Care (CC), often referred to as CTI (Continuous Home Care). This provision is activated when a patient experiences a short-term, acute medical crisis that requires immediate, round-the-clock intervention to manage uncontrolled symptoms and avoid hospitalization.
The Definition and Purpose of Continuous Care
Continuous Care (CC) is a temporary, elevated level of service designed to intervene during a hospice patient’s medical crisis. Its purpose is to provide intensive, predominantly skilled nursing support to manage severe, out-of-control symptoms directly in the patient’s home environment. This care ensures patients have access to necessary support 24 hours a day when their condition acutely worsens.
This intensive support differs significantly from Routine Home Care (RHC), the most common level of hospice service. RHC involves intermittent visits from the hospice team, scheduled around the patient’s general needs. Continuous Care, in contrast, is a crisis intervention providing a sustained presence of care to stabilize the patient during an acute episode. The goal is to resolve the immediate medical crisis so the patient can return to the intermittent support of Routine Home Care.
Eligibility Criteria for Continuous Care
A patient qualifies for Continuous Care based on medical necessity: they must be experiencing a crisis that cannot be managed by intermittent visits. The Centers for Medicare and Medicaid Services (CMS) define this as a period requiring continuous, predominantly nursing care to manage acute medical symptoms. The patient’s symptoms must be severe or unstable enough to necessitate constant skilled observation and intervention to maintain comfort and safety at home.
Qualifying circumstances involve acute symptom exacerbations resistant to standard hospice management protocols. Examples include sudden, unrelenting pain requiring frequent medication adjustments and close monitoring. Other situations involve severe respiratory distress, such as acute shortness of breath, or uncontrollable gastrointestinal distress like persistent nausea, vomiting, or diarrhea. Qualification is strictly tied to the medical requirement for continuous skilled intervention, not a general decline in the patient’s overall health.
Acute neurological or psychological crises, such as severe terminal restlessness, agitation, or sudden seizure activity, can also trigger the need for CC. The hospice team initiates this level of care when the symptom burden threatens the patient’s ability to remain in their residence. The focus remains on rapid stabilization of acute symptoms to restore a manageable level of comfort.
Staffing and Service Delivery
Receiving Continuous Care requires a minimum of eight hours of direct care provided within a 24-hour period (midnight to midnight). This care must be delivered by hospice personnel, with nursing services being the predominant component. Specifically, more than 50% of the total care hours must be provided by a Registered Nurse (RN) or Licensed Practical Nurse (LPN).
Nurses are on-site to provide skilled interventions, such as administering complex medication regimens, titrating pain and symptom control drugs, and performing continuous physical assessments. Hospice aides and homemakers supplement the nursing care, assisting with personal care tasks like bathing, dressing, and positioning. This collaboration ensures both the medical and comfort needs of the patient are met during the crisis period.
CC can be provided in the patient’s private home, an assisted living facility, or a long-term care facility, but not in an inpatient hospital setting. The duration of this intensive level is temporary, lasting only as long as the acute medical crisis persists and symptoms are unstable. Once symptoms are successfully managed and comfort is restored, the hospice team transitions the patient back to the intermittent, scheduled visits of Routine Home Care.