While the federal government is making billions of dollars available to health care providers through the CARES Act and other programs, the lion’s share of those funds and equipment is going to hospitals, often leaving providers in other settings out in the cold, including hospice.
Hospitals nationwide unquestionably are taking a tremendous hit due to the COVID-19 pandemic, including surges of patients, supply and equipment shortages, and exhausted, overworked staff who are often working in unsafe conditions due to the lack of personal protective equipment (PPE). However, hospices are facing many of those same challenges while receiving little support.
Shortages of PPE are among the most pressing concerns for hospices, not only due to scarcity, but because increased demand has been driving up prices.
“The biggest impact right now is sourcing [PPE]. Everyone is trying to source the same equipment, and the cost has gone up substantially,” Liz Fowler, CEO of Kentucky-based hospice provider Bluegrass Care Navigators, told Hospice News. “Prices for things like masks have gone up as much as 2,000%. Prices for items like gloves, goggles, face shields, hand sanitizer are going up that much. Traditionally, gloves and hand sanitizer might be sufficient for a hospice care environment, but now we have staff that need to wear goggles and have face shields down.”
The National Hospice & Palliative Care Organization (NHPCO) has estimated that the nation’s hospices would need as much as $800 million to $1.1billion to cover direct costs associated with the pandemic. These are typically costs that cannot be reimbursed by other sources, according to NHPCO.
While the CARES Act established a $100 billion Public Health and Social Services Emergency Fund to aid health care providers, none of those funds are earmarked specifically for hospices, who will have to compete with hospitals and other providers to access the funds.
NHPCO has written to officials overseeing the federal response to request that some of these funds be designated specifically for hospice providers, including Vice President Mike Pence, U.S. Health & Human Services Secretary Alex Azar and U.S. Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma.
“Hospice providers across the nation, including in ‘hot spots,’ are serving the most vulnerable people during this national emergency and as a result have incurred considerable expenses and lost revenue directly related to their COVID-19 response efforts,” the NHPCO letter said. “We request that you consider establishing a dedicated allocation for hospice providers under the Public Health and Social Services Emergency Fund to cover costs related to [PPE], staffing costs, and lost revenue.”
In addition to fighting for more PPE, hospices are wrestling with the need for overtime pay for employees, paid leave for staff who have been exposed to the virus, hiring of new staff and associated expenses, reduced referrals, cancelled fundraising activities, and difficulty accessing some patients, such as those who reside in nursing homes. Hospices also need additional durable medical equipment, particularly those that aid patients with respiratory disorders.
CMS and Congress have relaxed rules limiting telehealth services so that hospices can more readily interact with patients and families while practicing social distancing as much as possible. While this was welcome news to providers, this too came with additional costs for equipment, training and software licensing, Fowler said.
Some hospices may qualify for some relief through CARES Act programs, if not through public health dollars, then via small business loans. However, the limited number that qualify would be again competing for loans against potentially tens of thousands of businesses nationwide.
“[Bluegrass Care Navigators] doesn’t qualify under the small business assistance, but I’m sure some hospices do. Looking at the CARES Act, a lot of the funding and the relief that’s currently coming out related to COVID-19 is directed towards hospitals,” Fowler said. “We’re gonna have to advocate for some of those dollars to come to hospice.”