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Is providing continuous home care required?


Specializes in education,LTC, orthopedics, LTACH. Has 13 years experience.

I know I asked about this before, but my question here is very specific. We have actually opened the dialogue about this benefit, here at my hospice, which is a huge step forward! I am told that it is beleived that continuous home care is not required to be provided. I have looked through CMS standards and some OIG reports and can not find anything stating specifically that "all 4 levels of care must be offered". I wonder if someone can provide a link to this type of wording. I realize the benefit only should be used when appropriate.


Specializes in geriatrics, hospice, private duty.

I just know that no hospice agencies in my area provide continuous care, which is a main reason I got out of hospice nursing when I moved here. Continuous care is a vital part of hospice care in my opinion. I just assumed it wasn't required since no one here provides it (silly, I know). Every agency in my previous state offered it. I hope someone who knows the codes answers as I am curious myself.

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

In order to bill CMS for hospice care, hospices must be able to provide care according to the CoPs, which includes GIP, RESPITE, and CONTINUOUS CARE, along with ROUTINE level of care.

Many hospices do not provide that level of care in practice because it is so labor expensive and the documentation requirements are much different. On paper, they have that ability...but they avoid having to implement it.

The hospice that cared for my mother had a continuous care provision that they freely offered to my father when my mom was actively dying, he declined.


Specializes in Hospice, LTC, Rehab, Home Health. Has 20 years experience.

Continuous care is a level of care which may be provided in either of 2 ways: 1) in an inpatient setting such as an IPU or 2) in the patients home. In an IPU coverage is guaranteed as there is always licensed staff in the unit; in the patient's home all shifts are attempted to be covered but there may be uncovered shifts if needs exceed available staff. The continuous care label can also be misleading as it is maintained only for short periods and must be justified by the presence of uncontrolled symptoms and ends when the symptoms are controlled. Therefore, some agencies have replaced the term Continuous care with the more appropriate term crisis care.

I work for a small hospice agency that is only 1 year old and the majority of my patients have been in facilities or home with appropriate care so I have not yet needed to implement continuous care, however if there was truly a need we would implement it after reviewing with the team and MD. Even as a small agency that has not even started making a profit yet, we would never be told that we simply do not offer it.

CrunchRN, ADN, RN

Specializes in Clinical Research, Outpt Women's Health. Has 25 years experience.

In my area they do provide it. The RN case manager decides when death is imminent and then an LPN usually provides the care. They will do this I think just for 24 to 48 hours.

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

The RN determines there is a need, the MD orders that level of care, and the staff coordinate coverage. Imminent death, in and of itself, is not an indication for continuous care. There must be a level of need for symptom management, etc that justifies the change in care, and the documentation must meet the requirements to support that level of care.

That said, there are a number of hospices that fully utilize this LOC with excellent outcomes.


Specializes in Hospice, NICU. Has 30+ years experience.

Tewdles, I am so sorry for the loss of your mother. Your information is absolutely correct. In order to be MediCare certified, all 4 levels of care must be available. It is part of the COPs (Conditions of Participation).