Hospice leaders are adapting to limitations while supporting staff and volunteers as they face roadblocks to providing essential patient services. More than 40 states nationwide have issued stay-at-home orders prohibiting nonessential travel and closing businesses to minimize the exposure and spread of COVID-19.

While hospice services are a vital part of the health care continuum, the widely used term “essential services” has been loosely defined, leaving providers to set parameters themselves as they struggle to meet a wide variety of challenges during the COVID-19 crisis.

“Essential services are primarily being driven by the clinical needs of our patients coupled with the evolving regulations in the various care settings,” said Troy Yarborough, CEO of Hospice Care of South Carolina/Agapé Hospice. “We’ve shifted staff responsibilities, working to maintain high levels of connectivity with our existing patients and preparing for an increasing need.”

Maintaining in-person patient visits is one of the largest challenges hospices are currently facing. Some are seeing rising numbers of referrals as a result of COVID-19-positive patients. Staffing availability is one contributing factor as providers feel the impacts of school closures, supply shortages, increased screening protocols and mandated quarantines for those exposed or infected to the coronavirus.

“Due to the shortage of COVID-19 tests, any clinician who presents any COVID-19 symptom must stay home for the duration of the quarantine period — whether or not they’re positive,” Terese Acampora, COO of MJHS Hospice and Home Care in New York, told Hospice news in an e-mail. “The ripple effect is that healthy staff must cover the quarantined person’s visits and be at a greater risk of exposure and stress.”

Although the scope of essential care services has changed drastically during the crisis with several complimentary programs suspended, volunteers efforts are ongoing in support of vulnerable patient populations and their families. Hospices are still able to actively recruit despite limitations, with many receiving tremendous response from their local communities.

Providers are finding innovative ways to maintain patient care as they keep staff safe and healthy, such as following stricter COVID-19 infection prevention protocols. This has also impacted the ability of staffing and volunteer workforces to effectively provide the same level of human interaction as prior to the pandemic.

“We addressed transportation needs by creating the MJHS Ride Along Buddy program. The program allows employees with fewer work demands to volunteer as drivers to transport hospice clinicians to and from patient visitations throughout New York City,” said Acampora. “This has accomplished far more than we expected. Staff volunteers enjoy being helpful and have become a great source of emotional support. Hospice clinicians are also less at risk of COVID-19 exposure because they don’t have to rely on public transportation to get from one patient visit to another.”