When is Continuous Level of Care appropriate? How should it be documented?

A homemaker or hospice aide services or both may be covered on a 24-hour continuous basis during periods of crisis, but the care must be predominantly nursing care. 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 as described in Sec. 418.204(a) and only as necessary to maintain the terminally ill patient at home.

To document CHC in Hospice Tools use the CHC documentation provided within the Nurse Chart section of the EMR.

Suggested Work Flow:

1. Complete a Change in Level of Care form: to document that the patient transitioned from one level of care to another, this will also establish the official date in which the level of care changed. The Change in level of care form will go to internal MD for signature via the dashboard
2. Update the Level of Care on the Patient's Intake Screen: The patient's level of care should be immediately updated on the intake screen. ex: If the patient was a Routine Home Care, update to Continuous Home Care)
3. Recommended Documentation for CHC:
   • Recommend process for documentation at least hourly
   • Reason for continuous home care
   • Vital signs (as appropriate)
   • Observations of the patient’s condition
   • Interventions used to achieve palliation of physical or emotional symptoms
   • Services provided to the patient
   • Medications given and the patient’s response
   • Treatments completed and the patient’s response
   • Contacts made to the hospice and/or attending physician
   • New or changed orders received
   • Family response to care (as indicated)
   • Detailed discharge planning to transfer the patient back to routine home care as soon as the
   crisis subsides.
   • There is no specified frequency of documentation for CHC in the regulations or guidance. However, since CHC is for acute symptom management or some other crisis and billing occurs in15-minute increments, the best practice standard is to document at least every hour.
   • Suggest an MAR and narcotic count at each nursing staff shift change

Hospice Tools Documentation for CHC:

1. Continuous Initiation sheet: This document is used to provide specific details such as co-morbidities, team members assigned, state of crises, & specific orders
2. Continuous Care Specific Instructions :(this can be combined with the CHC Initiation sheet) email support@hospicetools.com for this document modification
3. Continuous Care Flow Sheet: This is used to take the patient's vitals, (this can be combined with the Continuous Care Hourly Documentation) email support@hospicetools.com for this document modification
4. Continuous Care Hourly Documentation: This should be completed every hour in which the patient is seen the RN,LVN,LPN, or Hospice Aides

* If the documentation is not assessible by the appropriate discipline please contact support to remove the nurse specific credential tie to the CHC documentation so that the other clinical staff

Hospice Tools Billing:

In order to bill for CHC hours, the hours will need to be entered in the ebilling module on the Patient's General Tab. If you do not have access the ebilling module, this will need to be completed by the employee who has access.

1. Click Patients, Find the patient. In the General tab scroll down to the to the level of care
2. Click on CHC Hours Covered hyperlink- A side panel will appear to enter the hours and dates applicable. The dates and hours entered should match the documentation completed in edocs

For more information:

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