26 Tex. Admin. Code § 266.211 - Continuous Home Care
CHC is provided only during a period of crisis for a maximum of five consecutive days to maintain an individual at the individual's place of residence.
(1) A minimum of
eight hours of CHC must be provided during a 24-hour day that begins and ends
at midnight. The care need not be continuous. For example, four hours could be
provided in the morning and another four hours in the evening of that
day.
(2) Skilled nursing care must
be provided for the identified crisis for more than half of the CHC period and
must be provided by either an RN or licensed vocational nurse. The RN or
licensed vocational nurse must be an employee of the hospice providing
services. For an individual residing in a nursing facility, the skilled nursing
care requirement is not met when facility staff provided skilled nursing care
for the crisis. For the purpose of CHC, skilled nursing care includes at least
one of the following:
(A) administration of
intravenous or intramuscular medications;
(B) insertion, sterile irrigation, and
replacement of catheters;
(C)
initial clinical assessment for specific therapeutic responses; or
(D) application of dressings involving
prescription medications.
(3) Homemaker, home health aide services,
medical social work, or chaplain services may be provided to supplement the
nursing care. The hospice must document why the physician considers social work
or chaplain services necessary to ameliorate the crisis and what these services
accomplished during CHC. On-call staff may be used to provide CHC but must be
on site, providing care to the individual in the individual's place of
residence to be considered for inclusion in CHC hours.
(4) The hospice must have a signed
physician's order for skilled nursing care. The physician's order must:
(A) be specific to the identified crisis and
be dated before the initiation of CHC, but not more than three days before the
initiation of CHC;
(B) document the
rationale for increased nursing needs and care; and
(C) be in the individual's hospice record and
plan of care.
(5) The
attending physician, hospice medical director or his designee, and the IDT must
establish the plan of care before initiating CHC. The hospice RN must
coordinate the plan of care. The plan of care must:
(A) be updated when the individual's
condition changes; and
(B) include
the following:
(i) a description of the
specific crisis and how the hospice plans to resolve the crisis;
(ii) the needs of the individual;
(iii) identification of the services needed
to meet the needs of both the individual and family, including management of
discomfort and symptom relief;
(iv)
the scope and frequency of the services needed to meet the needs of both the
individual and family;
(v)
documentation of daily physician care plan oversight; and
(vi) clinical findings and documentation that
support the scope and frequency of crisis care needed.
(6) Before initiating CHC, the
hospice must advise and discuss with the family or responsible party that
temporary alternate placement may be necessary at the end of the five
consecutive days. The hospice must document the discussion with the family or
responsible party in the individual's records, including:
(A) the date and time of the
discussion;
(B) the names and
titles of the participating IDT members;
(C) at least one potential alternate
placement; and
(D) any other
outcomes of the discussion.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.