Crisis Care, also known as Continuous home care (CHC), is one of the four levels of hospice care in the Medicare Hospice Benefit.
The purpose of continuous home care is to achieve palliation and management of acute medical symptoms. Continuous home care is only furnished during brief periods of crisis and only as necessary to maintain the terminally ill patient at home.
Continuous home care is meant to include predominately nursing care, covered for at least 8 hours, and up to 24 hours in a 24 hour period, beginning and ending at midnight. Hospice aide services may be covered on a 24-hour continuous basis during periods of crisis, but the care must be predominantly nursing care.
At Pacific Coast Hospice, our Crisis Care Program consists of the following team:
- Nursing care provided by an RN or LPN, employed by Pacific Coast Hospice—not contracted out.
- Services may be provided by a nurse practitioner that, in the absence of a nurse practitioner, would be performed by an RN or LPN.
- Hospice aide services to supplement nursing care.
- Services of social workers and pastoral counselors are often called upon during these periods of crisis, if warranted as part of hospice care, and are included in the provisions of routine hospice care.
Crisis Care may be provided only during a period of crisis. A period of crisis is defined as a period in which a patient requires continuous home care, which is primarily nursing care, to achieve palliation or management of acute medical symptoms. If a patient’s caregiver has been providing a skilled level of care for the patient and the caregiver is unwilling or unable to continue providing care, this may precipitate a period of crisis because the skills of a nurse may be needed to replace the services that had been provided by the caregiver. Other appropriate times to consider Crisis Care include:
- Frequent medication adjustment to control symptoms/collapse of family support system.
- Symptom management/rapid deterioration/imminent death.
Crisis Care is generally not appropriate in the following situations:
- For a patient who is imminently dying with no acute skilled pain or symptom management needs.
- For caregiver breakdown with no acute skilled pain or symptom management needs. (As stated above, if a patient’s caregiver has been providing a skilled level of care for the patient and the caregiver is unwilling or unable to continue providing care, this may precipitate a period of crisis because the skills of a nurse may be needed to replace the services that had been provided by the caregiver.)
- Crisis Care is not intended to be used as respite care.
- For safety concerns (for example, falls, wandering, etc.) in the absence of a need for skilled interventions.
- As an alternative to paid caregivers or placement in another setting.
Crisis Care is only furnished during brief periods of crisis and covered only as necessary to maintain the terminally ill individual at home. If you are interested in requesting Pacific Coast Hospice’s Crisis Care Program, please speak with your Nurse Case Manager immediately.