Growing patient and family concerns about safety are among the many challenges the end-of-life care community is facing during the ongoing coronavirus pandemic. As hospice providers meet patient care needs during the outbreak, an added challenge is alleviating patient concerns about staff coming into the home.
As the novel virus continues to spread, so do ongoing updates on the disease’s mode of transmission, symptoms, progression, incubation period, treatments, and possible long-term effects. Hospice patients are among the highest risk population, and updates continue with recommendations and guidelines for providing care. The U.S. Centers for Medicare & Medicaid Services. (CMS) issued interim infection prevention and control guidance last month for home- and community-based health care personnel that includes information on worker and patient safety as well as screening recommendations..
“The federal government is revising new rules for providers and changing requirements, such as waiving restrictions in order to increase access of telehealth measures,” said Thomas Cornwell, M.D., executive chairman of Home Centered Care Institute (HCCI), founder of Northwestern Medicine HomeCare Physicians and senior medical director of Village Medical at Home, part of Chicago-based VillageMD. “To protect both the provider and patient, pre-screening questions can help determine the level of risk for COVID-19 prior to the home visitation. Questions can include risk assessments such as respiratory symptoms.”
The pandemic is placing new demands on hospice providers as they work to prevent the spread of COVID-19 and reassure patients receiving care in their homes that allowing hospice workers into their residence remains safe.
“We’ve seen an uptake in terms of our population of patients mirroring the rising concerns across the United States,” said Troy Yarborough, chief executive officer for Hospice Care of South Carolina (HCSC) and Agapé Hospice, which HCSC recently acquired. “We’ve certainly had more patients that are asking for more information.”
Hospice providers are using various communication strategies to proactively address and respond to patient and family concerns during the pandemic. Calls, e-mail communication, website information and social media announcements and updates are circulating to ensure information accessibility.
“We are communicating with our residents to remind them that their needs will continue to be met and that essential health care services, including hospice services, will be continued without interruption,” said Erin Shvetzoff Hennessey, chief executive officer of Minnesota-based post-acute consulting firm Health Dimensions Group. “They are also reassured that any allowed visitors to the community, even those for end-of-life visits or essential care workers, are all being screened for illness in an effort to reduce their exposure to COVID-19.”
Along with increased communication, providers can reassure patients and families about their level of risk and the factors involved. Hospice providers are trained and experienced in working with patients and families to ease their doubts and fears.
“Home care is actually safer as a one-on-one visitation rather than going into a hospital or doctor’s office with larger populations and increased risk factors,” said Cornwell. “Of course, it is best to discuss a patient’s preferences and concerns prior to home care visitations, and respect if they prefer not to have anyone enter their home to reduce risk to themselves or others living in or entering in the home.”
Reaching out to patients and families not only provides reassurance about the precautionary measures and infectious disease protocols, it can further develop the relationship and trust built between providers and the people they serve.
“Calling patients before going to see them gives them the opportunity to ask us questions,” said Laura Mosby, vice president of compliance and organizational excellence for Florida-based Empath Health, which operates Suncoast Hospice. “It’s increased communication with patients, and I think that is really helpful to provide them with reassurance.”
In addition to addressing patient concerns are the worries of hospice staff as they seek to reduce risks to both themselves and to patients when entering the homes.
“Home health care workers can reduce exposure risk to themselves and patients by wearing personal protective equipment (PPE) such as the N95 face mask, eye protection and gloves in a technically guided way to ensure that no germs are left behind in the patient’s home,” suggested Cornwell. “Additionally, providers are advised to limit the time length of a home visit and also physical contact with the patient by practicing social distancing measures to minimize and limit exposure both to themselves and the patient.”
Bringing minimal equipment and ensuring diligent sanitization both before and after also minimizes possible infection risk. Minimizing PPE use also helps sustain limited supplies during a period of increasing demand.
Hospices can also collaborate with their local health departments to stay on top of updated guidelines in their service areas, in addition to guidance for COVID-19 guidance from CMS or the U.S. Centers for Disease Control & Prevention (CDC).
“Ensure you’re using equipment under the right circumstances at the right timing per CDC guidelines,” suggested Yarborough. “Equally as important is to stretch limited reach of resources as long as possible in hopes that the supply chain begins to catch up with the need.”