South Florida Hospital News
Friday February 26, 2021
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June 2005 - Volume 1 - Issue 11
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When There’s a Crisis, There’s Continuous Care

Continuous Care may be one of the best-kept secrets in geriatric medicine. But it shouldn’t be – because Continuous Care is a win-win situation for hospice patients, their families, their nursing homes, their attending physicians.

Some 90 percent of patients faced with life-threatening illness prefer to remain in their homes, in the bed they know, surrounded by people they love, continuing the routines that make them comfortable. Whether they are in their family homes, adult living facilities or nursing homes, they want to age – and die – in place.

Continuous Care makes that choice possible. Even in a period of crisis, when there is pain, nausea, confusion or a change in level of consciousness, Continuous Care puts a trained, skilled clinician at the bedside up to 24 hours a day.

"Continuous Care prevents sending a resident to the emergency room," says Bob Miller, vice president of hospice operations at VITAS Innovative Hospice Care®. "At a time when the patient is most vulnerable to confusion or disorientation, Continuous Care keeps her in familiar surroundings. She feels at home and calm."

That’s important to the patient’s stabilization. "Studies show that even a slight change in the environment of a seriously ill elderly patient increases her decline," says Susan Acocella, general manager of VITAS’ Palm Beach program. "At that point Continuous Care becomes a psychosocial measure." Continuous Care is the equivalent of inpatient care, offering the same intense level of palliative care—but without moving the resident.

"Continuous Care has been one of the four levels of care authorized under the Medicare Hospice Benefit for more than 20 years," Acocella points out. "But it is woefully underutilized. Only recently have other hospices begun to offer this service at all, let alone as widely as VITAS offers it."

Miller agrees. His message to physicians unaware of the Continuous Care benefit is this: "Expect that someone skilled and trained in observation and intervention will be available to your patient, one on one, up to 24 hours a day. And, for appropriate patients, it will be covered by Medicare, Medicaid or private insurance. Even if the patient’s insurance has no Continuous Care benefit, VITAS will try to negotiate with the insurer, because of the measurable benefits to the patient and the patient’s family."

VITAS has a commitment to providing Continuous Care to every appropriate patient. "On any given day we have a significant number of patients receiving Continuous Care in the South Florida area," says Miller.

More than half that care must, by law, be provided by a nurse, and the plan of care is managed by a nurse. "Any hospice offering Continuous Care needs the commitment of skilled nurses and aides willing to work long hours caring for people in the most vulnerable moments of their lives," Miller adds. "In addition, the hospice must provide a significant amount of administrative and logistical support for these workers.

"Our staff isn’t hesitant to refer patients to Continuous Care," he says, "because we have plenty of people and resources to go around. But it took us a long time to get to that point. VITAS pioneered Continuous Care on a broad scale, and I think, because of our example, other hospice providers have stepped up to the plate. But we continue to lead."

"VITAS is all about choices," says Acocella. "Not all hospice patients need to go to a unit; we follow the wishes of the patient and family entirely. But there is this perception that hospice means going to—or ending up in—a place. Hospice isn’t a place. Hospice is a philosophy; it’s a way to take care of a patient with a life-limiting diagnosis. And with Continuous Care, we can take that care wherever the patient calls home."

When is Continuous Care Appropriate?

Continuous Care is for terminally ill patients experiencing acute physical symptoms as well as emotional, spiritual and psychosocial challenges that make it difficult to receive care in their residence.

The criteria for establishing Continuous Care may include any of the following:

  • Uncontrolled pain
  • Respiratory distress
  • Intractable nausea, vomiting or diarrhea
  • Changes in level of consciousness, restlessness, agitation
  • Seizures
  • Uncontrolled bleeding
  • Any other symptom resulting in distress to either the patient or family
Deborah Cumbie Director of Admissions, VITAS Innovative Hospice Care® of Palm Beach County, can be reached at 1-800-93-VITAS.
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