At Compassion Crossing Academy, we offer short, self-directed classes that help you learn with confidence. Each unit is designed for quick, meaningful progress in 30 to 120 minutes. We turn complicated topics into clear guidance you can understand and apply.

It's 2 AM. Your patient's wife is panicking on the phone. "He can't breathe. The pain is out of control. I don't know what to do. Should I call 911?"

You know your patient is in crisis. But what happens next? Do you call the doctor first? Contact your clinical manager? Start continuous care immediately? One wrong step could mean a denied claim worth thousands of dollars—or worse, a patient sent to the hospital when they wanted to die at home.

This is the moment that separates confident hospice nurses from those who second-guess every decision. Most hospice nurses can't tell the difference between a real crisis and normal disease progression. Your patient's breathing is getting worse. Is that severe dyspnea requiring 8 hours of continuous nursing care? Or is it just expected decline? The wife is exhausted and begging for help. Does caregiver stress alone qualify for continuous care?

Without clear clinical criteria, you're guessing. And guessing costs your agency money when Medicare audits your charts. One audit can cost your hospice $50,000 or more in repayments. You weren't trained on the specific clinical indicators that separate a billable crisis from routine care.

Let's say you do everything right. You assess the patient. You call your manager. You get the doctor's order. Continuous care begins. Now comes the hardest part: documentation.

Medicare requires documentation at least every hour. Best practice? Every 15 minutes. But here's where nurses fail: they write things like "patient stable," "no changes," or "waiting for next dose time."

Those three phrases just killed your claim.

If the patient is stable with no changes, why does Medicare need to pay $1,000+ per day for continuous care? Your documentation must prove—hour by hour—that without your skilled nursing presence, this patient would be in the hospital. If you can't show that, the claim gets denied. Your agency loses revenue. You get blamed.

Even when you think you've figured it out, the chain of command trips you up. Your patient meets continuous care criteria. You call the doctor. The doctor writes the order. You promise the family continuous care. Then your clinical manager tells you there's no staffing available. Now you've got an angry family, a confused doctor, and no plan.

The correct pathway is precise: assess the patient, call your clinical manager to confirm staffing, then call the doctor with a proper SBAR report. If staffing isn't available, you pivot to General Inpatient Care. But nobody gave you a step-by-step decision tree.

Here's another trap: the 50% nursing rule. You provide 4 hours of nursing and 6 hours of hospice aide care. That's 10 total hours. Continuous care requires at least 8 hours, so you're good, right?

Wrong.

Medicare requires that at least 50% of all continuous care hours must be nursing hours. Your 4 hours divided by the total of 10 hours equals 40%. You bill routine home care. Not continuous care. If you bill continuous care anyway, you've committed a billing error. When aide hours exceed nursing hours, thousands of dollars in claims get denied.

Continuous care decisions are high-pressure. Under-utilize it, and your patient suffers. Families panic. Patients end up hospitalized when they wanted to stay home. Over-utilize it, and your agency wastes resources while Medicare audits your charts. You're stuck in the middle with incomplete training. You freeze. You second-guess yourself. You avoid making the decision.

What if you had a clear, step-by-step system that took all the guesswork out of continuous care? What if you knew exactly when a patient qualifies, exactly who to call, exactly what to document, and exactly how to calculate billing correctly?

"Continuous Care in Hospice: A Clinical Decision-Making Guide" walks you through the exact clinical criteria that separate a real crisis from normal decline. You stop guessing and start assessing with confidence. You'll learn the precise chain of command: who to call, when to call them, and what to say using the SBAR framework that doctors respect.

The training breaks down the 50% nursing rule with real examples, so you can calculate correctly and never bill incorrectly again. You get hour-by-hour documentation templates that show the exact phrases that prove medical necessity and those that trigger audits.

Real patient case studies show you exactly what to do when staffing is available, when it's not, and when the patient doesn't qualify at all. You'll see the GIP decision tree in action—how to pivot seamlessly when continuous care isn't available. You'll also get 10 downloadable handouts, including quick-reference guides, a decision tree flowchart, SBAR templates, documentation examples, and billing checklists.

Imagine the next time you get that 2 AM crisis call. You don't panic. You assess the patient using clinical criteria you've mastered. You follow the chain of command perfectly. You document every 15 minutes with phrases that justify the care. You calculate the nursing percentage correctly. You transition the patient back to routine care when the crisis resolves—confident your documentation will survive any audit.

You become the nurse your team depends on.

This training was created by Peter M. Abraham, BSN, RN, EOLD—a hospice nurse who has published over 500 healthcare articles and authored 21 books specifically for hospice staff training. He's been exactly where you are and created the roadmap so you never have to guess again.

Enroll today and gain immediate access to the full training plus all 10 handouts. Every nurse on your hospice team needs this knowledge before the next crisis hits. Don't wait until the next audit. Don't wait until your patient is hospitalized because you didn't know the criteria.

Master continuous care now. Your patients—and your agency—are counting on you.