Hospice care focuses on comfort and quality of life for individuals facing a life-limiting illness, prioritizing symptom management and emotional support over curative treatment. Within hospice services, a distinct and intensive level of support exists for times of acute medical instability, known as Hospice Crisis Care or Continuous Home Care. This specialized service addresses sudden, severe changes in a patient’s condition that cannot be managed through routine hospice visits.
Defining Hospice Crisis Care
Hospice Crisis Care, formally termed Continuous Home Care (CHC), is an elevated level of service provided during an acute, temporary symptom crisis. This service is required under the Medicare Hospice Benefit and is distinct from routine home care visits. Its primary purpose is to provide intensive, skilled support to manage the crisis and stabilize the patient in their home setting.
This care requires direct patient care for a minimum of eight hours within a 24-hour period. The care must be predominantly skilled nursing, meaning more than 50% of the total hours are delivered by a Registered Nurse (RN) or Licensed Practical Nurse (LPN). The clinical focus remains on continuous observation and intervention by licensed staff to achieve swift palliation of symptoms.
Criteria for Activating Continuous Care
Activation of continuous care is based on an acute medical crisis where the patient’s symptoms are uncontrolled and require continuous skilled nursing to remain safely at home. The hospice team, led by the physician, must determine that the patient’s comfort and safety are at risk without this intensive support. Qualifying symptoms are severe and refractory to the care plan established during routine visits.
Examples of triggers include uncontrolled pain requiring frequent medication adjustments, severe respiratory distress, and unrelenting nausea and vomiting. Acute neurological symptoms like terminal agitation, restlessness, or delirium that pose a safety concern also warrant activation. The clinical team must document the specific crisis and the need for continuous skilled observation to justify the increased level of care. If symptoms are under control, the criteria for this crisis level of care are generally not met.
Duration and Location of Service
Hospice Crisis Care is a temporary intervention intended to last only until acute symptoms are stabilized. While the duration varies, it often lasts between 24 and 72 hours, though it can extend longer if the crisis persists. Once the patient’s symptoms are successfully managed and comfort is restored, the level of service transitions back to Routine Home Care.
This intensive care is provided wherever the patient resides, such as a private home or an assisted living facility. Hospice staff deliver the service in shifts to ensure continuous coverage, often up to 24 hours per day, as long as the acute crisis continues. If symptoms cannot be managed effectively at home, the patient may require a short transfer to an inpatient hospice unit for General Inpatient Care.
Understanding Financial Coverage
For patients who have elected the Medicare Hospice Benefit, Hospice Crisis Care is one of the four levels of care fully covered by Medicare Part A. The cost for this intensive, 24-hour-per-day skilled care is covered 100% by Medicare. The patient is typically not responsible for any deductible or copayment for the continuous care service itself.
The comprehensive coverage includes skilled nursing services, hospice aide services, and any medications, supplies, or equipment necessary to manage the terminal illness during the crisis period. Patients covered by Medicaid or private insurance plans usually have similar benefits for continuous care, though patients should always verify their specific coverage details. This financial provision ensures patients can receive the necessary level of care to maintain comfort at home.