Pandemic Reshaping Hospice Bereavement Care

The coronavirus pandemic has been reshaping the ways hospices provide bereavement care. Many providers have taken these services online as COVID-19 forced the need to socially distance, with hospices working quickly to implement new technology platforms. Given these investments, many of these changes will likely extend into the long term.

The U.S. Centers for Medicare & Medicaid Services (CMS) requires hospice providers to offer bereavement counseling for a minimum of 13 months following a patient’s death, but hospices often go above and beyond by making grief care available to their entire communities, regardless of whether the deceased was their patient.

With COVID-19 spurring an extensive need for bereavement care, many hospices need additional resources to meet rising demand.

“The pandemic has created an exponential increase in the need for access to bereavement services. The pandemic creates a strain on the ability to meet the demand for these services, particularly for families who had a loved one die from COVID without the support of hospice,” said President and CEO of the National Hospice and Palliative Care Organization, Edo Banach.

A range of organizations have also asserted the need for a National Grief Strategy in the wake of the pandemic.

COVID-19 has claimed more than 2.9 million lives globally since its onset, according to a recent World Health Organization report. More than half a million U.S. lives (558, 843) have been lost to the deadly virus, according to the most recent data from the U.S. Centers for Disease Control and Prevention (CDC).

“Throughout the year, we served more than 12,000 uniquely-bereaved clients, that’s an increase of well more than 1,000 from what we saw in 2019,” said Yelena Zatulovsky, vice president of patient experience for Illinois-based Seasons Hospice & Palliative Care. “We ended up having 32 bereavement groups and psycho-educational reform workshops that ran weekly or bi-weekly in half of our sites covering the entire nation just so that we could maintain connections between people.”

Seasons merged with post-acute provider AccentCare late in 2020. The hospice and palliative care provider has consolidated their counseling resources within its local community and beyond in response to the volume and depth needed, according to Zatulovsky. 

Traditional bereavement services are provided in-person through individual and group counseling, workshops and grief camps for children and families experiencing a loss. Many of these programs came to a grinding in 2020 even as the need for them rose.

Hospices have responded to the need to innovate to maintain the continuity of care while also reducing the risk of spreading the virus, turning to telehealth to provide interdisciplinary services, including bereavement care. One-on-one or family discussions with chaplains and social workers, or participation in support groups, are moving online along with activities such as face-to-face recertifications and some routine home care visits.

This has come at a cost to providers in terms of implementing new technology systems, including the need to train staff remotely to use new systems. Hospices also worked to ensure that staff and families have access to the technology necessary to make these changes work, along with providing a private and confidential environment.

Despite these hurdles, going virtual has allowed some hospices to expand their programs.

“There is an increase in attendance due to the convenience of telehealth, and clients seem more relaxed in their own environment and do not have to worry about negotiating traffic to make their appointment,” said Sarah King, director of social work, bereavement, volunteer services and chaplains for Florida-based LifePath Hospice, part of the Chapters Health System. “We do find that we are seeing survivors that we may not have reached if we continued to only offer in-person visits.”

As King told Hospice News, LifePath Hospice has developed an online program for families that provides the physical tools needed to participate in grief exercises together. The model will continue to be offered on Saturday mornings, to create a less-stressful time frame for families to find a balance with work and school schedules.

Portland-Ore. based Kaiser Permanente Northwest Continuing Care Services ramped up employee training to provide bereavement care as the demand for counseling exceeded the number of available staff. Joelle Osterhaus, Kaiser’s hospice and palliative care psychosocial services manager and interim palliative care operations manager, told Hospice News that bereavement education and skills training expanded across the organization to those who do not usually provide this kind of support as part of their regular job.

With the future of telehealth rules uncertain at this point, hospice providers are navigating murky waters ahead. In the meantime, providers may have much to gain from lessons learned during the pandemic, with hospices considering varied ways to strike a balance between virtual and in-person care.

“This year COVID has impacted all grief experiences. Even though not all deaths were from COVID, the normal pathways and rituals surrounding death and dying were much less accessible to people,” said Osterhaus. “Even when things become more safe to resume in person work, we will likely need to continue to leverage virtual care in order to meet the new demand. This is just likely the tip of the iceberg. This time is not only rich in losses, but rich in learnings on how we can best adapt to grief and grievers to provide support as caring professionals.”