Hospice care provides comfort and support for individuals with a life-limiting illness, focusing on quality of life rather than curative treatment. While care typically involves routine, scheduled visits, an acute medical crisis sometimes requires a higher, more intensive level of support. This intensive service is often internally referred to as Continuous Team Intervention (CTI), representing a rapid deployment of specialized care.
Defining Continuous Care in Hospice
The hospice service often called CTI is formally designated under Medicare guidelines as Continuous Home Care (CHC). This is one of the four mandated levels of hospice care defined under the Medicare Hospice Benefit. Unlike Routine Home Care (RHC), which involves intermittent visits, CHC is a short-term, intensive intervention used for the rapid palliation and management of acute medical symptoms that cannot be controlled through intermittent care.
Continuous Home Care is not a permanent state but a time-limited response to a temporary medical emergency. The goal of initiating CHC is to stabilize the patient so they can return to the Routine Home Care level as soon as possible. This high-intensity service is designed to maintain the terminally ill individual at home during their medical crisis.
Criteria for Initiating Continuous Care
The decision to initiate Continuous Home Care is based on strict clinical requirements demonstrating that a patient’s symptoms are uncontrollable with their current plan. The symptoms must be acute and severe, demanding the continuous presence of skilled staff.
Examples of acute symptoms that necessitate CHC include severe, uncontrolled pain requiring frequent titration of analgesic medication. Other qualifying issues are acute respiratory distress, intractable nausea and vomiting unresponsive to initial treatment, or severe anxiety and restlessness often described as “terminal agitation.”
To qualify for CHC, the patient must require a minimum of eight hours of care within a single 24-hour period, which starts and ends at midnight. Furthermore, the care delivered during this time must be “predominantly nursing care,” meaning that skilled nursing services from a Registered Nurse (RN) or Licensed Practical Nurse (LPN) must account for more than 50% of the total hours provided. If this skilled nursing threshold is not met, the day cannot be billed as Continuous Home Care, even if the total time exceeds eight hours.
The Structure of Continuous Care Delivery
Continuous Home Care is structured to provide intensive support directly in the patient’s place of residence, which may be a private home or an assisted living facility. The care team is typically composed of Registered Nurses and Licensed Practical Nurses, who provide the required skilled nursing interventions. Hospice Aides are also integrated into the team to supplement the nursing care, providing personal care and assistance.
The primary objective is to maintain a continuous presence of clinical staff during the crisis period, often aiming for 24-hour coverage until symptoms are controlled. The term “continuous” refers to the intensity and duration of the patient’s need for care, not necessarily a single, uninterrupted shift by one person.
Once the patient’s acute symptoms are successfully managed and stabilized, the level of service is immediately “stepped down” to Routine Home Care. Continuous Home Care is a fully covered benefit under the Medicare Hospice Benefit for patients who meet the strict criteria, and most private insurance plans follow similar guidelines for coverage.