I have a patient with intractable terminal agitation. The family does not want to use respite, as they want to keep them at home. They do not want to hire caregivers because of liability concerns. They trust us-hospice. However, I am told we do not have the manpower to provide continuous home care. From my research and talking with a few others I found out that this level of care is SUPPOSED to be offered (see quote from about.com). I feel as though this family should have this benefit, but if I open my mouth I will lose my job or have some type of issue. I love my job, but this is weighing on my mind. The guilt is horrible when I leave, but I have to go home to my family. I have considered staying for several hours on my own time, but this isn't how it should have to be. Any thoughts or suggestions? I know if I told this family about this, they would raise the roof to have the benefit, but I am sure I would be found out as putting them up to it, so I don't want to do that either. I value my job, and I can't risk making waves for the sake of my family, but I feel like my integrity is taking an nosedive. "If a patient develops physical or emotional symptoms that aren't easily managed with routine care, continuous care may be an option. Continuous care provides more intense care in the patient's home environment. A nurse and/or a home health aide will remain in the patients home environment for a minimum of 8 up to 24 hours per day to administer medications, treatments, and support until the symptoms are under control. Some examples of symptoms requiring continuous care would be unrelieved pain, severe nausea and vomiting, severe shortness of breath, anxiety or panic attacks, or a breakdown in the primary caregiver support system. Continuous care is considered a short term level of care and is reevaluated every 24 hours"