Disclaimer: Westlake Village Hospice Inc. is a licensed and Medicare-certified hospice care provider. We do not sell, prescribe, dispense, or ship prescription medications, and we do not operate an online pharmacy or telemedicine prescribing service. All hospice services are provided in person by licensed healthcare professionals. Any references to Medicare coverage, medication support, or medical coordination relate solely to patient care delivered under physician direction and do not constitute prescription drug sales or online medical services.
Continuous Home Care and Crisis Nursing
Continuous Home Hospice Care
Intensive nursing support provided in shifts up to 24 hours a day during medical crises, allowing patients to remain at home.
Managing Medical Crises at Home
Continuous Home Care (often called "Crisis Care") is a short-term, intensive level of service provided when a patient experiences acute medical symptoms that cannot be managed by routine visits alone. Instead of transferring the patient to a hospital or inpatient unit, we bring hospital-level nursing to the bedside.
When is Continuous Care Provided?
This level of care is implemented for uncontrolled symptoms such as:
- Severe, breakthrough pain
- Uncontrolled nausea or vomiting
- Severe respiratory distress (dyspnea)
- Acute agitation or panic
- Seizures
- Unstable bleeding
How It Works
Medicare regulations state that care must be provided for a minimum of 8 hours within a 24-hour period (beginning at midnight). At least 50% of this care must be provided by a Licensed Nurse (LVN or RN), with additional support from Home Health Aides. The goal is to aggressively manage symptoms until the patient is stable and can return to Routine Home Care.
The Benefits of Crisis Care
Rapid Stabilization
Immediate, expert adjustments to medication and treatment protocols.
Avoid Hospitalization
Prevents the stress and trauma of ambulance rides and emergency rooms.
Peace of Mind
A nurse is at the bedside, ensuring the family is not alone in handling the crisis.
Need immediate assistance?
Our team is available 24/7. If you believe your loved one is in crisis, call us immediately.
818-791-0611Continuous Home Care: Intensive Crisis Support at Home
Continuous Home Care (CHC) is one of four Medicare-defined hospice service levels, specifically designed for medical crises. It represents the highest intensity of hospice care that can be delivered in the patient's home, providing a safety net that keeps families out of the emergency room during some of the most frightening moments of the hospice journey.
Under Medicare regulations, Continuous Home Care is defined as care provided during a period of crisis when the patient needs "nursing care to achieve palliation or management of acute medical symptoms." The minimum requirement is 8 hours of skilled care within a 24-hour period, with more than half of those hours provided by a Registered Nurse (RN) or Licensed Vocational Nurse (LVN).
When a Westlake Village Hospice patient enters a crisis, our on-call nurse responds immediately — 24 hours a day, 7 days a week. We assess the situation, activate Continuous Home Care when clinically warranted, and dispatch nursing staff to the home. Our goal is to stabilize the crisis as quickly as possible, with maximum comfort and minimum disruption to the patient and family.
When Is Continuous Home Care Medically Appropriate?
CHC is activated by a clinical determination from our hospice physician and RN — not by request. It is appropriate when any of the following acute conditions arise:
Uncontrolled Pain
Breakthrough pain that cannot be managed with the current medication schedule. The nurse administers emergency medications under physician orders and adjusts the standing prescription to prevent recurrence.
Terminal Restlessness / Agitation
Delirium near the end of life, marked by confusion, picking at bedclothes, repetitive movements, and extreme distress. Skilled nursing management with appropriate sedation protocols restores comfort.
Respiratory Distress
Air hunger, labored breathing, secretion accumulation ('death rattle'), or severe breathlessness. Skilled nurses manage the airway, position the patient, and administer medications to relieve the sensation of breathlessness.
Intractable Nausea & Vomiting
When nausea is severe and unresponsive to oral medications, the nurse can administer subcutaneous or rectal antiemetics and work with the physician to adjust the medication regimen.
Acute Seizures
Skilled nursing management of seizure activity, including administration of rescue medications, airway maintenance, and rapid physician communication for plan adjustment.
Acute Caregiver Crisis
When the primary family caregiver reaches a breaking point and is physically unable to care for the patient safely, Continuous Home Care provides the bridge needed to stabilize the home situation.
Continuous Home Care vs. Routine Home Care: Key Differences
| Feature | Continuous Home Care | Routine Home Care |
|---|---|---|
| When used | Active medical crisis or symptom emergency | Stable periods between crises |
| Nursing hours | Minimum 8 hrs/day; often more | 2–5 visits/week typical |
| Medicare rate | Higher daily rate (crisis rate) | Standard daily rate |
| Duration | Temporary — until crisis resolved | Ongoing throughout hospice enrollment |
| Cost to patient | $0 (fully covered by Medicare) | $0 (fully covered by Medicare) |
| Trigger | Clinical crisis determination by RN + MD | Standard plan of care |
Frequently Asked Questions
What is Continuous Home Care in hospice and when is it used?
Continuous Home Care (CHC) is an intensive level of the Medicare hospice benefit used during medical crises to keep a patient comfortable at home and avoid hospitalization. It requires a minimum of 8 hours of skilled nursing or aide care within a 24-hour period. CHC is activated when a patient is experiencing uncontrolled pain, severe respiratory distress, intractable nausea or vomiting, severe agitation, or a similar acute symptom crisis that would otherwise require hospitalization. It is always a temporary measure — once the crisis is resolved and symptoms are stabilized, the patient returns to Routine Home Care.
Does Medicare pay for Continuous Home Care?
Yes. Medicare Part A covers Continuous Home Care at a higher daily reimbursement rate than Routine Home Care, reflecting the intensity of services provided. The patient pays nothing out of pocket. The hospice agency bills Medicare for the continuous care days directly. A licensed nurse or aide must be present for at least 8 hours in a 24-hour period, and more than half of those hours must be provided by a licensed nurse (RN or LVN).
Is Continuous Home Care the same as 24-hour home nursing?
Not exactly. Continuous Home Care is a Medicare-defined hospice benefit that requires a minimum of 8 nursing hours in a 24-hour period during a crisis. It does not mean a nurse is present all 24 hours, though in severe cases that level of support may be arranged. The goal is crisis stabilization, not permanent around-the-clock staffing. If a patient or family requires a nurse present at all times as a long-term arrangement, that typically falls outside what Medicare's standard hospice benefit funds.
How quickly can Continuous Home Care be activated?
Continuous Home Care can be activated very quickly — often within 1–2 hours of our nurse assessing a crisis situation. Our hospice nurse evaluates the patient, determines that the clinical threshold for CHC is met, contacts the hospice physician for orders, and dispatches additional nursing resources. We are available 24 hours a day, 7 days a week, 365 days a year for exactly this reason.
What symptoms most often trigger Continuous Home Care?
The most common reasons a hospice patient transitions to Continuous Home Care include: acute uncontrolled pain (breakthrough pain that the current medication schedule cannot manage), terminal restlessness or agitation (delirium at end of life, also called 'terminal agitation'), severe respiratory distress including air hunger or secretion crises ('death rattle'), intractable nausea and vomiting causing dehydration risk, acute seizures, and severe emotional crisis in the patient. Our clinical team assesses these symptoms at every visit and monitors for early signs to prevent full crises when possible.
Experiencing a Crisis Right Now?
Our nurse is on call right now — 24 hours a day, every day. One call activates our crisis response. Do not go to the emergency room first — call us.
Call 818-791-0611 — Crisis Line Open 24/7