Hospice care focuses on comfort and quality of life for individuals with a terminal illness. Within this framework, a specific and intensive service exists for times of acute need. This service, known as Hospice Crisis Care (HCC), provides immediate, high-level support when a patient’s symptoms become overwhelming. HCC is an acute level of service within the overall hospice benefit, reserved for the most unstable periods.
Defining Hospice Crisis Care
Hospice Crisis Care (HCC), formally referred to as Continuous Home Care (CHC) under the Medicare Hospice Benefit, is a temporary, intensive service provided during acute symptom exacerbation. This level of care differs from Routine Home Care (RHC), which involves intermittent visits from the hospice team. The defining feature of HCC is the provision of continuous, predominantly skilled nursing care to manage an acute medical crisis at home or in the patient’s residence. The primary goal is the rapid stabilization of uncontrolled symptoms that cannot be managed effectively with routine hospice care. This allows patients to remain in their preferred setting rather than requiring transfer to a hospital or an inpatient hospice unit.
Clinical Eligibility Requirements
Qualification for Hospice Crisis Care hinges on severe, uncontrolled clinical symptoms requiring continuous skilled observation and intervention. The patient must be in a “period of crisis,” defined as a time when continuous care is necessary to achieve palliation or management of acute medical symptoms. Being close to death or having a caregiver experiencing burnout does not qualify a patient for HCC if their symptoms are stable. Specific symptoms that trigger eligibility require continuous skilled nursing oversight and intervention. The ultimate decision to initiate HCC is a clinical one, made by the hospice team based on documented patient need for continuous skilled nursing care.
Qualifying Symptoms
Specific symptoms that typically trigger eligibility include:
- Severe, unrelenting pain that requires frequent medication adjustments and constant monitoring to stabilize.
- Acute respiratory distress or air hunger that is not relieved by routine interventions.
- Intractable or uncontrollable nausea and vomiting.
- Acute hemorrhaging.
- Unmanageable anxiety, restlessness, terminal agitation, or frequent seizures that interfere with comfort.
Intensity of Care and Staffing Model
The delivery of care during the crisis period involves a heightened level of attention compared to routine hospice services. To meet HCC criteria, the patient must receive a minimum of eight hours of care within a 24-hour period, which must be predominantly nursing care. This means that more than 50% of the total continuous hours must be delivered by a Registered Nurse (RN) or Licensed Practical Nurse (LPN).
This care is administered through continuous staff shifts, often extending to 24 hours a day if acute needs demand it. The staff provides real-time assessment, administers medications, and adjusts treatment protocols in constant communication with the hospice physician. Hospice aides can supplement nursing care by assisting with personal care and comfort measures, but the skilled intervention remains the responsibility of the nursing staff. This intensive care can be provided in the patient’s private home, an assisted living facility, or a nursing home.
Duration and Transition Back to Routine Care
Hospice Crisis Care is designed to be a temporary intervention, lasting only as long as the acute medical crisis persists. It is typically provided for a short duration, often between 24 and 72 hours, but can be extended if symptoms remain unstable and require continuous management. The hospice team must document the medical necessity for this heightened level of care daily.
Once acute symptoms are stabilized and can be managed effectively with intermittent visits, the crisis care status is discontinued. The patient then transitions back to Routine Home Care. This benefit is not intended to provide long-term, round-the-clock custodial or residential care. The goal is to return the patient to a stable state to continue receiving comfort care through the standard hospice benefit.