COVID-19’s Impact on Hospice Referral Relationships

The COVID-19 crisis is reshaping routine interactions with referral sources as hospices strategize ways to manage those relationships in rapidly changing conditions.

Even prior to the pandemic, developing stronger connections and communications with referral partners was a critical goal for most hospices. Providers consistently work to boost referrals and ensure smooth collaboration with partners. As demand for hospice care continues to grow, referrals remain key for hospice business sustainability and development — especially considering the financial pressures resulting from the pandemic.

“It is estimated that in total COVID-19 will cost the global economy at least $2.7 trillion dollars, that would include hospice and home health,” Shelley Cartwright, CEO of APEX Hospice and Palliative Care in Illinois, told Hospice News. “As the number of individuals afflicted with the virus continues to spiral upward, we have begun to see a decrease in hospice referrals. We have made our referring partners aware of our coronavirus policy, as well as our daily emergency preparedness plans that will allow us to continue to admit new patients.”


With hospitals and health care systems under pressure in the pandemic, keeping the lines of communication open is even more crucial. This kind of relationship management in a time of crisis requires a deeper level of respect and understanding of each organization’s priorities, coupled with a willingness to collaborate on those priorities, as CEO Joy Berger of Kentucky-based Composing Life Out of Loss highlighted in a recent Hospice News webinar.

“Whether or not we are infected with COVID-19, we are all affected by it,” said Berger. “The hope is that the current crisis environment is bringing referral partners and hospices together. The concern is that it has potential to move them further apart. There’s a push and pull balance. A time to push our energies and go the extra mile, and a time to pull back and voice your needs. If we’re always just pushing, it’s going to lead to burning up a relationship, and also if you’re consistently pulling back. We need to be fluid, and the core piece is going to come down to respecting the other’s perspective with empathy.”

In terms of voicing needs, hospices can clearly communicate their admission processes during the pandemic with existing and new referral partners. Clarifying protocols preemptively can continue to build the bridge between partners and hospices to help ensure smooth transitions of care. Additionally, this transparency can help ease the concerns of patients and their families when it comes to the risk of COVID-19 exposure.


“Now is the time for hospices to establish relationships with primary care physicians, assisting them to assure their patients with chronic illnesses are safe. Not because of tainted relationships with referral sources or the inability to connect with referral sources through e-mail, telephone and social platforms, but because patients and their families are in fear,” Cartwright said. “Creativity and communication will be the key moving forward to maintain hospice referral and admissions. During the pandemic hospices can offer support to hospitals, physician offices and skilled nursing facilities. We could designate PPE for our hospice personnel and donate a portion to skilled nursing facilities. Our best tool currently is that our agency has not made cutbacks that would affect the culture or quality that hospice care lends to patients and their families.”

Having unifying strategies in place can potentially lead to deepened and expanded referral partnerships. The resilience of these relationships can stem from creative and compassionate ways hospices and referral partners are figuring out how to support one another as they balance different hardships.

“The best can come of this,” Berger told Hospice News. “There’s hope that hospice professionals and care team members are going to provide long-term care facilities a wealth of understanding of their expertise and perspective and bring some practical solutions to them. Resilience isn’t about just plowing through. This is hard and terrible, but hospice has an army of services that are meaningful to offer and provide to their partners with an uncanny ability to improvise with each other and themselves in these kinds of crisis circumstances.”

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