Arizona Hospices Collaborate to Meet Patients’ Non-medical Needs During Outbreak

A group of hospices and home health agencies in small Arizona communities are working with local businesses, such as restaurants and other community resources, to ensure that isolated patients receive meals during the COVID-19 pandemic.

Collaborative efforts are bringing communities together as the coronavirus pandemic touches every corner of the globe. Building unifying relationships with community organizations to address patients’ nonmedical needs — including social determinants of health — is increasingly important for hospice providers to continue care for high-need patient populations who are also at greatest risk of the disease’s effects.

As recent data from the Kaiser Family Foundation shows, adults age 60 and older are substantially more vulnerable to COVID-19 infection, with those suffering from diagnoses most common among hospice and palliative care patients at the highest level of risk. Protecting and continuing to serve these patients is challenged by the crisis’ impacts on workforce capacity, supply availability and patient interaction.


“We can’t run from what’s happening, we have to run toward it,” said Maria Pynakker, outreach coordinator of Living Waters Hospice in Golden Valley, Ariz. “That involves thinking outside the box and asking how we as providers can serve more and serve better. The answer changes every day in this crisis because the norm changes every single day, and our network in this small corner of the world just tried to be in front of it.”

Living Waters has joined forces with local restaurants, community organizations and competing hospices to ensure patient needs would continue being met. The meal and supply program took off when collaborations formed with Hospice of Havasu, Billet Home Health and Hospice, and several of the region’s food producers and other companies. These assets united together to bring hundreds of meals weekly to vulnerable seniors and shut-ins throughout the area.

“Every time there is a need in our community, we always try to collaborate together,” Pynakker told Hospice News. “We just didn’t realize that the need this time was going to be so great for our elders.”


Basic needs such as toilet paper, paper goods and meals are among the supplies being gathered and distributed as a result of the collaborative efforts. Pynakker first reached out to the area’s casinos, which shut down in light of the COVID-19 pandemic. Donations of food and other necessities began pouring in to meet the needs of the community’s senior population. Responses ramped up after the partnering companies promoted the effort on social media and as local news reports spread the word.

“We came together for the benefit of the community,” said Anita Bray, president of the Mohave Sunrise Rotary Club and owner of Javalina’s Coffee Express, both of which are participating in the collaboration. “We were looking for a partner to do something during this crisis. Our goal is to effectively make sure seniors with compromised health get a meal and stay [safe] at home.”

Javalina’s is one of several restaurants working with providers to provide meals for patients being cared for by as many as 12 participating home health and hospice agencies. Reaching a capacity of 600 meals per week, the collaborative delivers three meals per person each Wednesday. Volunteers and staff preparing and delivering the meals are using preventative measures to protect both service teams and patients alike.

“Everyone has their temperature taken,” Bray said. “We know the virus can take a bit to show but this is our first step. There’s also handwashing, gloves and hair nets. Donations are met at the door and delivery drivers are wearing protective gear when dropping off, with no contact involved.”

As Pynakker explained, the least amount of interaction possible is an important consideration, as is patient privacy. Patient packages are held in a staging area to which personnel access is limited to protect patient privacy. While an important safety precaution, social distancing has placed a strain on the level of care possible for hospice and elderly patients.

“Part of hospice care is that personal interaction with patients,” said Pynakker. “We’re going to get out there and still administer and do what we do best for the patient, and never take out the elements of humanity and love. What we are doing is helping people out with this program, but it can’t go on forever, even if with all of these amazing partnerships.”

The program is set for reevaluation at the end of April to address evolving patient needs, along with the sustainability of the program among the partnering hospices and community service providers. Financial pressures and supplies are among the most significant barriers to continuing the program.

While the work of these Arizona hospices is a response to the current national emergency and is not driven by participation in any payment models, leveraging partnerships with community resources to address nonmedical patient needs will likely be an important skill set for hospices to develop in anticipation of the 2021 implementation of the Medicare Advantage hospice carve-in and Primary Care First Serious Illness Population (SIP) payment model.

The U.S. Centers for Medicare & Medicaid Services (CMS) earlier this year announced that Medicare Advantage plans will begin covering supplemental nonmedical benefits in 2020. CMS will begin testing a Medicare Advantage carve-in for hospice in 2021, giving participating hospices access to those supplemental payments.

The SIP model, a component of CMS Primary Care First initiative, requires participating health care providers, including hospices, to develop relationships with community resources to address patients’ nonmedical needs and social determinants of health.

“COVID-19 just really brings to light that there’s such a need for these people out there,” Pynakker said. “Strong community partnerships like these are absolutely part of the spectrum of care for hospice patients. We as providers need to make sure that they are still being taken care of as they deserve.”

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