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Continuous Home Care
- 1. Continuous Home care By Rosemary Nevarez
- 2. Continuous Home Care (CHC) • Nursing care from a RN/LVN/LPN, homemaker, hospice aide • Crisis care at home • Nursing care for atleast 8 hours in a 24 hour period. • The purpose of continuous home care
- 3. Assessment • Surveys • Families grievances • Patients in crisis
- 4. Appropriate vs not appropriate Appropriate Crisis Examples: Intense pain Bleeding Acute respiratory difficulty Uncontrollable Nausea & vomiting Restlessness at the end of life Not Appropriate Imminent patient Caregiver breakdown Respite Safety concerns placement
- 5. Staff Nursing Care • RN • LVN • LPN • NURSE PRACTITIONER • HOMEMAKER • HOSPICE AIDE
- 6. Computation Hours • Must provide 8 hours/24 hours of nursing care • Does not have to be continuous • Nursing care more than 50% • Reimbursement as a routine visit when not all 8 hours are met. • Care provided by nurse, homemaker or hospice aide
- 7. Documentation • Hourly documentation that consists of: • Reason for CHC • Vital signs • Observations • Interventions • Services provided
- 8. Documentation • Medications administered • Treatments • Contacts made to Doctors • Family response • Discharge • MAR & narcotic count
- 9. stakeholders • Centers for Medicare and Medicaid services • Families • Patients • Caregivers • Clinicians
- 10. goals • Patient to be as comfortable as possible • Families to not be scared, well educated & understand the process • Feel support and know the hospice team is there for them & care
- 11. Outcome • Not able to proceed due to not enough staff • Not sustained but can be • Next steps
- 12. Overall experience The experience was very interesting and at the same time very educational. I have had more than 15 years experience in hospice and I am always trying to find ways to improve and help my patients and family be more at ease with them being under hospice care. I found that this project would be a great way of helping not only for my patients and families but for our organization. I find that easing them from being scared and finding them comfort is the ultimate goal. Even though this project was not able to construe to the end, it will happen in due time. I found it very promising for my organization, families, patients, and for the future of healthcare.
- 13. References • Continuous Home Care in the medicare hospice benefit. (n.d.). Retrieved April 20, 2022, from https://www.nhpco.org/wp-content/uploads/CHC_Compliance_guide.pdf • Health, A. S. I. (2020, November 11). Hospice Continuous Care: A little known benefit with huge rewards. Allied Services Integrated Health System. Retrieved April 18, 2022, from https://www.allied-services.org/news/2020/november/hospice-continuous-care-a-little-known- benefit-w/ • Hospice. (2021, November 11). What is continuous care in hospice: Definition, information. All American Hospice. Retrieved April 18, 2022, from https://myallamericanhospice.com/what-is- continuous-care/ • Stakeholder engagement. CMS. (n.d.). Retrieved April 20, 2022, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/MMS/Stakeholder- Engagement#:~:text=Stakeholders%20are%20individuals%20or%20organizations,dev
Editor's Notes
- What is Continuous Home Care? Nursing care that is provided when a crisis has been noted in their home, assisted facility, a long term facility on non skilled nursing facility if the patient is not receiving a skilled level care. Nursing care consist of a RN/LVN, home maker , or hospice aide that will consist of at least 8 hours in a 24 hour period. “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 in the medicare hospice benefit. (n.d.).
- In hospice we have to know how we are doing overall and one way of knowing how the organization is doing is by giving out surveys. These surveys are shown for everyone to see online. Surveys show our organizations performance. In these surveys it has shown how families have expressed grievances on how they would’ve liked more education on the dying process, on how their loved one expired in pain, and on how they felt they could’ve done more in a time of crisis.
- In order for CHC to work patients have to be going through a crisis. This would make it either appropriate or not appropriate. Examples of being appropriate would be a patient in hospice that can be exhibiting the following examples; intense pain, bleeding, acute respiratory difficulty, restlessness distress at end of life, and or uncontrollable nausea and vomiting. Compared to when not appropriate would be patients that are in the dying process but in no distress or system management needs, no respite care, safety concerns, caregiver breakdown and or another way of placement for patient.
- Nursing care has to be provided by a nurse (RN/LVN/LPN) that is employed by hospice, a nurse practitioner although if no NP available then a nurse would have to be readily available, homemakers and hospice aides supplement the nursing care. Services of other team members such as social workers , chaplains, counselors, would still continue but not be counted towards continuous home care and would not be able to bill for.
- The hospice must provide 8 hours in a 24 hour period which begins and ends at midnight. The care does not have to be a continuous of 8 hours but can be provided 4 hours in the morning then the other 4 in the evening. As long as 8 hours of nursing care ae provided. Nursing care meaning an RN/LVN/LPN providing more than 50% of care. For example, Providing nursing care more than 4 hours of and 8 hour care in a 24 hour period from an RN/LVN and or LPN. The rest of the care can be provided by a homemaker or hospice aide. If nursing care is provided less than 8 hours the visit will be reimbursed as a routine home care visit.
- Documentation is very important in all aspects and will need to show the services that were implemented to meet the plan pertaining to that particular crisis. Documentation will consist of hourly documentation that will show the reason for the care, vital signs, observations, interventions, and services that were provided.
- Medications that were administered, any treatments, contact physicians, how the family has responded and discharge and planning. It would be wise to have a MAR(medical administration record) and narcotic count at end of shift to keep track.
- Valuable stakeholder input informs quality measurement projects at each stage of the Measure Lifecycle as well as outside that framework. Stakeholder may input inform the shape and structure of CMS resources, such as Care Compare, or help inform CMS needs and priorities (Stakeholder engagement. CMS. (n.d.).
- Several goals to keep in mind would be for our patients to live out their remaining days at home with their loved ones, to have family's understand the process that they are going through so they can know how to take care of their loved one at home. Level of support gives caregivers the ability to step back and be able to handle the situation differently knowing and seeing that someone else is their to help and guide them to the right direction.
- The outcome of the project was not able to be implemented due to shortage of staff. Staff is required to be able to help for multiple hours of the day until the crisis has alleviated. It has not been sustained but can be. CHC can be used to help patients and families understand, be more comfortable and be less in distress having a professional be there when a crisis is needed to alleviate the problem. Until the crisis is alleviated the nursing care can be dismissed and when this is done the families will be more calm. This will help the families and patients but also the organization. The interdisciplinary team that is involved will see that the families are more hospice affiliated and are aware of hospice philosophy and services. They will come to understand the process and progression of the patient more openly and will know how to handle the changes that will come to play. The next steps to ensure that this project can come work is to make sure we have enough staff. Once we have enough staff we will be able to help patients in crisis more efficiently.