What is Continuous Home Care in Hospice?

It’s a common wish for older loved ones to age at home for the remainder of their life. Roughly seven in 10 seniors would prefer to die in the comfort of their own home, according to a recent Kaiser Family Foundation poll.^[01] Data shows that this option is becoming increasingly available with the right help: The number of in-home deaths increased by over 7% between 2003 and 2019, and that number continues to rise, according to The New England Journal of Medicine.^[02]

There are three primary benefits of continuous home care:

1. Choice. Continuous hospice care at home allows your loved one to comfortably live out the remainder of their time on their own terms and in a familiar and supportive setting.
2. Support. A dedicated team of people specially trained in this type of care will be available to communicate what your loved one’s experiencing and guide you through their needs.
3. Connection. You’ll have the opportunity to focus on what’s important: being able to spend quality time with your loved one while professionals handle their care.

Continuous home care includes palliative care, medical assistance, and help with activities of daily living (ADLs). This type of care does not provide treatment for chronic conditions or diseases, but rather offers relief from painful symptoms.

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What do continuous home care providers offer?

Continuous home care in hospice combines a variety of services that work together to keep your loved one comfortable as they experience serious health concerns and side effects toward the end of life.

Continuous home care may include the following:

• Palliative care, or relief of symptoms and suffering caused by a serious medical condition, such as cancer or another chronic condition or disease
• Management of acute medical symptoms, such as severe pain, nausea and vomiting, sleep loss, or loss of appetite
• Assistance with ADLs that a senior cannot perform independently, such as bathing, eating, and using the toilet
• Spiritual or emotional support from a counselor or chaplain familiar with end-of-life care

Who practices continuous home care?

Continuous home care must be mostly in-home nursing care. In other words, it needs to be provided by a registered nurse, licensed vocational nurse, or licensed practical nurse. That said, many seniors who require continuous home care also need help with ADLs, such as dressing, bathing, and using the toilet.

Nursing care can be supplemented by home care aides or homemaker services provided by nonmedical caregivers. However, at least 50% of care must be provided by a medical professional for it to qualify as continuous home care, according to CGS Administrators.^[03]

If your loved one needs more daily help from a home care aide, those hours are contracted and billed separately through the home care agency or provider. For example, if your relative needs four hours of nursing care but six hours of help with daily tasks like meal preparation, transportation, or personal hygiene, you would pay the home care agency or aide directly for the additional two hours.

Read more:Understanding the Different Qualifications of In-Home Nurses and How to Hire

To receive continuous home care, your loved one must first qualify for hospice care. To qualify for hospice, a senior must have an estimated six or fewer months to live, as determined by their doctor. They must also choose to no longer pursue a cure for their condition, but rather to focus on management of symptoms and pain.

A doctor will likely provide a list of partner hospice agencies who are able to offer continuous care. If your family would prefer a specific hospice provider — for example, a religiously affiliated company or one that offers additional services — you can work with your loved one’s doctor to set up a connection.

What qualifies as continuous home care in hospice?

Note that continuous care is a specific type of hospice designed for seniors experiencing a significant medical crisis. Even if your loved one qualifies for hospice, they may not need the level of medical attention continuous home care provides.

There are several distinctions that set continuous home care apart from other types of hospice care, according to the Centers for Medicare and Medicaid Services.^[04] These include the following circumstances:

• At least 50% of care must be provided by a medical professional. This does not include home health care aides — providers must have degrees in nursing.
• Care must take place for at least eight out of every 24 hours, with at least four hours provided by medical professionals.
• Care that spans midnight (for example, 7:00 p.m. to 1:00 a.m.) does not qualify as continuous care.
• A doctor or nurse must determine that your loved one is experiencing a medical crisis or concern that warrants this level of care.

Once your family determines that hospice care is the right choice for your loved one, there are several options you can explore to fund hospice care at home.

Medicare, Medicaid, veterans benefits, and private insurance all generally cover part or all of continuous home care in hospice. Community organizations and volunteers may also help sponsor families without the resources to pay for care. Though the same funding options apply for continuous home care and hospice, continuous home care is billed differently.

Here’s a closer look at how different funding options can help pay for hospice care at home.

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Medicare

Many seniors use Medicare benefits to pay for continuous care at home. To qualify, a senior must meet the four care requirements listed in the previous section, along with the following:

• Have Medicare Part A (hospital insurance)
• Have an estimated life expectancy of six months or less
• Have the need for significant medical care
• Choose to pursue comfort care rather than to cure an illness or condition

Those who qualify don’t have to pay for continuous hospice care at home, but they may have to provide copayments for prescription drugs or medical devices.

Medicaid

Since each state administers Medicaid programs differently, benefits may vary based on where your loved one lives. Some states may require shorter or longer life expectancies than the aforementioned six months to provide Medicaid benefits for continuous home care. However, Medicaid will only pay for symptom management, not to treat terminal illnesses, unless a recipient is younger than 21 years old.^[05]

VA benefits

The U.S. Department of Veterans Affairs provides continuous hospice care at home as a benefit for qualifying veterans and their families.^[06] The VA provides the hospice benefit to veterans with a terminal illness who aren’t expected to live longer than six months and who are no longer seeking treatment. The VA partners with community organizations to provide this care.

Private insurance

Depending on a senior’s policy, private insurance may pay for continuing home care in hospice. Talk with an agent or read through your loved one’s policy to see if they qualify for these benefits. Services and coverage may vary.

If your relative opted into long-term care insurance earlier in life, their policy may cover various types of hospice care at home.

Out-of-pocket payment

Many families rely on savings, pensions, and other private funds to cover aspects of hospice care at home. Though insurance often covers most hospice costs, there can be additional expenses, like medical devices and personal care products. When setting up continuous home care, speak with the provider about what’s included and what you’ll need to pay extra for.

How does billing for continuous home care work?

Continuous home care services are generally billed in 15-minute increments, and agencies track how much of that care is provided by medical professionals, according to the National Hospice and Palliative Care Organization.^[07] If the amount of time spent with a home care aide, companion, or home health aide exceeds time spent on medical care, those hours will be billed to the family separately as either standard hospice care or home care, depending on your loved one’s needs.

If your loved one needs extra care at home, but you’re not sure if they’re ready for continuous care, reach out to one of A Place for Mom’s Senior Living Advisors to discuss other home care or home health care options, all at no cost to you.