Hospices Face Ethical Dilemmas During the COVID-19 Pandemic

The COVID-19 pandemic has brought on a number of unprecedented ethical questions as hospice and palliative care leaders work to continue providing crucial services to their most vulnerable patients, including the need to limit contact between staff and patients, drawing a line between safety and the traditional hospice care model.

Honoring end-of-life goals while caring for patient and family needs can be a delicate balance for hospice and palliative care providers.

“It’s a very different environment we’re working in now,” said Bob Parker, chief clinical officer at Intrepid USA, a nationwide service provider of home health, hospice and palliative headquartered in Texas. “There are so many barriers that come into play.”


Among the most significant of these barriers for hospice and palliative care leaders is easing staff anxieties and fears as they come into direct contact with patients, especially those with known exposure to COVID-19. As staff are tasked to keep up with the latest updates to minimize risk, deciphering between fact and fiction has become an ethical challenge for leadership to address in providing information.

“There was so much misinformation, so much panic and fear out there and people are reacting from that position,” Parker said. “It was a lot of work to help people move past some of these thought processes because they were so afraid of this unknown thing that was happening. What our leadership has started doing is a daily town hall meeting to address what kind of rumors our staff is hearing and making sure everybody has the right information to let them know that we’re right there with them. They were able then to start really working within their communities to help others start reducing their own anxieties and fears.”

Another barrier for hospice and palliative care providers has been admitting and accessing patients among COVID-19 infection prevention measures. Many settings have restricted face-to-face care to patients with the most urgent and immediate needs. Assessing these critical-need situations has been challenging with initially slow response from regulatory agencies, raising ethical questions for providers.


While the U.S. Centers for Medicare & Medicaid Services (CMS) has announced several new regulatory flexibilities allowing hospice providers to adjust operations and billing processes, there is much left to interpretation as organizations work to address immediate challenges brought on by the pandemic.

National organizations have stepped in to fill some of the gaps during the crisis with increased resources for hospice and palliative care providers. The National Hospice and Palliative Care Organization (NHPCO) developed a free ethical framework for decision-making as a guide for providers awaiting more regulatory guidance related to the COVID-19 crisis.

The framework highlighted utility, or acting to produce the greatest good, as one of the most relevant ethical principles underlying the pandemic. The challenge for leadership has been deciding how to best ensure the greatest good in a safe and appropriate manner for both staff and the patients while minimizing risks to their organization’s overall practices.

“We may have created some level of survey risk, or we may have created some billing anomalies or issues that could drive down revenue,” Parker told Hospice News. “But that was the burden of the benefit in still making sure that we are taking care of patients. It isn’t about making money or making sure you are doing every single thing right. We will know on the other side of this crisis that we did things ethically to take care of patients.”

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