Continuous Home Care Shift Note (CHC)

Continuous Home Care (CHC) Shift Note

Patient Name: [Patient name]

DOB/MRN: [DOB / MRN]

Location: [Residence type and address/facility name]

Date of Service: [MM/DD/YYYY]

Shift Start Time: [HH:MM]

Shift End Time: [HH:MM]

Clinician: [Name, credentials, discipline]

CHC Status: [Initiated / Continued / Discontinued] this shift

Crisis Justification

[Crisis narrative] (Write 2–3 sentences describing: the acute symptom or situation requiring CHC; when it began or escalated; and why routine home hospice care is insufficient. Include objective evidence of severity such as symptom scores, vital signs if clinically appropriate, or observable distress indicators. Conclude by affirming that the required care is predominantly skilled nursing rather than custodial.)

Assessment & Care Log

Shift Start Assessment

Observed: [General appearance, level of distress, focused findings for crisis symptom(s), relevant devices/therapies in place, safety risks] (Document clinician-observed/measured findings only.)

Reported: [Pertinent patient or caregiver reports relevant to the crisis] (Clearly label as reported.)

Caregiver context: [Availability, capacity, ability to participate in care] (Include if pertinent to the crisis.)

(If expected assessment elements are not obtained, document the reason—e.g., patient refused, would increase distress, equipment unavailable.)

Hourly/Time-Block Documentation

(Repeat for each hour or clinically significant time block. Each entry should include patient status related to the crisis, interventions performed with indication and response, and any provider communication or caregiver teaching. When no active intervention occurs, document a brief skilled observation tied to the crisis rather than stating "no change.")

Time Block [HH:MM–HH:MM]: [Patient status and symptom score if used] [Skilled interventions with medication dose/route/time or non-pharmacologic measures] [Response to interventions with reassessment timing] [Provider communication and orders received, if any] [Caregiver teaching topics and understanding demonstrated, if any]

Time Block [HH:MM–HH:MM]: [Patient status and symptom score if used] [Skilled interventions with medication dose/route/time or non-pharmacologic measures] [Response to interventions with reassessment timing] [Provider communication and orders received, if any] [Caregiver teaching topics and understanding demonstrated, if any]

(Continue pattern for additional time blocks as needed. Ensure each medication administration includes indication, exact administration details, and effectiveness reassessment with timing.)

Time Accounting

Direct Care Time by Discipline:

• RN: [minutes]
• LPN/LVN: [minutes]
• HHA/Homemaker: [minutes]

Excluded Time: [Activities and minutes not counted as direct care, such as meal breaks, shift report, documentation, travel, coordination calls]

Calendar-Day Split (if shift crosses midnight): Day 1 through 23:59: [minutes] | Day 2 from 00:00: [minutes]

Threshold Attestation: Total CHC-eligible direct care minutes for calendar day: [minutes] | Nursing time exceeds 50% of total CHC time: [Yes / No] | 8-hour minimum met: [Yes / No] (If thresholds not met, document actual minutes and clinical justification.)

End-of-Shift Summary & Plan

Current Status: [improving / stable / worsening] — [Brief summary of symptom control and trajectory]

Level of Care Recommendation: [Continue CHC / Step down to Routine Home Care / Escalate to Inpatient] — [Rationale and criteria for step-down readiness or escalation triggers]

Handoff: [Pending tasks or orders, anticipated risks, next reassessment timing]

Signature: [Electronic/handwritten signature]

Printed Name/Credentials: [Name, credentials]

Date/Time Signed: [MM/DD/YYYY HH:MM]

(Separate reported information from observed findings throughout. Each shift note must reflect actual crisis, actual interventions, and actual response—avoid copying forward from previous shifts.)