Heart of Hospice’s Carla Davis: Rise to the COVID-19 Challenge

Carla Davis is the CEO of South Carolina-based Heart of Hospice. She came into that role with diverse compliance, operational and sales experience including as chief operating officer of VistaCare, and vice president of sales and marketing at Heartland Home Health Care and Hospice, a division of HCR ManorCare.

Davis has kept Heart of Hospice on a growth trajectory, with a focus on same-store, organic growth. She has a strong background in compliance including experience with one of the country’s largest Medicare Administrative Contractors, Palmetto GBA, educating and regulating hospice providers. She has helped initiate and execute hundreds of hospital and hospice partnerships across the country. Davis serves as a board member for the National Hospice and Palliative Care Organization (NHPCO) and as the president of the Alliance for the Advancement of End-of-Life Care.

Hospice News caught up with Davis via telephone to discuss how her organization is responding to the COVID-19 pandemic.


What is the role of hospice care providers during the coronavirus pandemic?

Hospice is a really important part of the solution that the severely-hit markets are facing. It’s important that we rise up to the challenge. Those of us in hospice are the perfect people to help take care of our most frail and elderly and get them out of the hospital and keep them out, wherever they call home. While this is certainly new for all of us, we face situations where we are helping to take care of very acutely ill people in unique home environments, keeping them out of the hospital, and helping to reduce anxiety and fear — that’s what we do every day. I think our caregivers are positioned to be able to do that and to help shoulder some of the burden that the families are feeling at this time.

This is the time for hospice to really help our communities heal because the healing in this pandemic isn’t just going to take place in the hospitals; it needs to take place in the community. Hospice can play an even more vital role in the future than we have in the past.


How is Heart of Hospice making changes to its operations due to the COVID-19 outbreak?

Logistically, we’re doing daily assessments of our patients and employees, along with screening to make sure that if there are any symptoms then they are appropriately receiving the right advice to either go to their physician to be tested or quarantined, depending on the situation.

We also created a COVID Task Force, with different aspects of responsibility assigned to experts from our senior leadership team. The task force has been really helpful as a source of truth for our employees, and also to make decisions together as a team. The task force consists of our chief medical officer, chief compliance officer, nursing staff, a vice president of clinical services and more. We all come together to pull our opinions and our research and divide on that. Immediately within 24 hours of forming the COVID Task Force, it created educational materials for our patients and families on both signs and symptoms in preventative practice.

How are you responding in regards to patient and employee safety in terms of infection control?

We’re redefining in-person visits as those that need to take place in person in order to accomplish pain and symptom management. Visits will include physical care that needs to be provided either by an aide or a nurse where there was otherwise no other solution.

At this point, we are providing visits every two weeks by a nurse at minimum, even if that visit doesn’t have to take place in person, because we think of it as a minimum standard that every dying patient should be able to receive. As things change minute by minute, we may update our perspective.

We’ve placed a great importance on [personal protective equipment (PPE)] and making sure it’s being used appropriately and educating staff on understanding when not to use PPE so we can preserve it for the occasions when it is needed. We’ve also created our own stockpiles so that we have supplies throughout the entire territory in all our locations and special locations and it can be moved because we’re basically our own supply chain now. We can’t count on the medical supply companies at this point. We’re having to source our own PPE from all kinds of innovative sources. We took immediate inventory of supplies across all of our locations, and then we started to procure it from all different kinds of places so that we will have enough to be able to protect our patients and their families and our staff.

We want to make sure that we as an organization, and our employees and patients served, are secure. Right now, this is defined by having enough PPE and good screening processes and making sure that everyone has an understanding how and when to utilize these.

How are you responding to any challenges in meeting patient needs and addressing those concerns?

We’re encouraging our physicians to have end-of-life care conversations sooner with palliative care and hospice patients and families, also with any of their elderly patients and families, or those that might be considered in a high-risk situation and any of the long term care residents. Nurse practitioners and physician teams can have advance care planning conversations through telemedicine. Now is absolutely the time for these conversations, before patients are diagnosed with something as serious as the coronavirus and they need to make tough decisions fast.

People who in the past might have been more scared of even the word hospice are now more accepting, because it means they’re going home and receiving care there during the COVID-19 outbreak. It means that they can be cared for in the safety of their homes. In some strange, positive way, at least from our experience, more people are getting access to hospice.

What are some measures you’re taking short-term to minimize potential effects of the outbreak?

We are trying to imagine and forecast what things may look like in coming months, both the smaller and larger impacts. We’ve committed to keeping Heart of Hospice employees whole as our greatest asset, at least to the extent that we can in the short term, and then we can reevaluate after a 30-day period. I expect that on the backside of this, we’re going to really need employees in order to maintain taking great care of patients and families.

How is COVID-19 outbreak impacting your hospice organization as a business in terms of revenue?

Financially, I think it’s too early to tell. We’ve spent a lot on supplies. Mileage costs are expected to go down. Our goal is to make it through this, and to make it through doing the absolute best we can to try to help dying patients, especially those dying from COVID-19, to get the care that they need. As a result, we have seen an increase in referrals and admissions, and they appear to be shorter lengths of stay.

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