As the COVID-19 pandemic continues, hospices are honing their screening procedures to protect staff as they visit patients’ homes. However, many challenges resulting from the pandemic’s pitfalls have placed a strain on providers as they work to protect patients and their workforce.
Many hospices geared up their prevention measures at the pandemic’s onset. Hospices bolstered existing infection prevention measures in compliance with new guidelines for the novel coronavirus from the U.S Centers for Disease Control and Prevention (CDC) and the U.S. Centers for Medicare & Medicaid Services (CMS). CMS guidelines featured screening processes to protect health care workers who operate in the home and community, including hospice providers.
Yet, many providers felt the federal guidelines came too slow to stem the pandemic’s rapid spread, leaving hospices to establish their own COVID-19 screening procedures for home care staff. Much of the pitfalls and challenges in effective screening have come from hospice providers struggling to implement policies quickly and bring staff up to speed, especially among smaller organizations or those in under-resourced rural areas.
“As we have all learned through this pandemic, our federal government was not prepared and gave late warnings to front line workers as well as the general public on being safe in fighting this pandemic,” said Sharon Branham, president and CEO of Appalachian Hospice Care, serving rural Kentucky counties. “Hospices were caught at a disadvantage like other providers who do not generally keep a large on hand supply of personal protective equipment (PPE), especially in-home providers.”
Despite challenges, national organizations, including some hospice companies, have increased availability of screening and infection prevention guidance, such as written policies developed by hospice and home health provider LHC Group (NASDAQ: LHCG). Procedures feature specific screening measures to share with patients such as cleaning surfaces in the home regularly with disinfectant, sanitizing the bottom of shoes after being in public or removing them before entering the home, and not allowing visitors into the home unless they are health care providers.
Other providers have stepped up day-to-day precautions for staff visiting patient homes. Measures include pre-visit staff questionnaires to stay on top of any possible symptoms and consistent reevaluations of level of risk and potential exposures.
“There has been an evolution to daily staff screening,” said Linda V. DeCherrie, M.D., clinical director of Mount Sinai at Home, in a recent webinar from the Home Centered Care Institute (HCCI) on the impact of COVID-19 in home-based care. “Screening now assumes complete community spread and it’s really focused on the symptoms of COVID-19. We prepare for the home visit with a checklist, realizing not all of our providers had soap and paper towels with them, which we made sure they had. Screening is one of the most important things we can do at this time.”
Recording temperatures daily has become common practice for many field staff, along with revising other processes when visiting patients in the home.
“We reviewed and re-educated staff on standard universal precautions and discussed transmission of the virus,” Branham said. “Each staff were given paper bags to use for immediate placement of PPE utilized after seeing patients. They were instructed on use of cleaning reusable medical equipment, such as stethoscopes, blood pressure cuffs, goggles, and the pens and notebooks carried into the home. Additionally, information was given to them on handling of fill-ups at gas stations and cleaning their credit cards after use, and they were given a working staff memo as well.”
Appalachian Hospice Care’s memo included preventive guidance for staff such as placing calls to patients prior to visits, using a COVID-19 screening tool, removing PPE outside the patient’s home, disinfecting vital sign and point-of-care equipment before and after use, using disposable bags over personal, reusable bags, and prohibiting jewelry, artificial nails, and nail polish when making patient visits.
Providers have also struggled with the limited availability of tests and associated supplies, such as swabs. “There simply were not enough tests for people with symptoms,” said Branham. “If the staff or their families continued to show symptoms, we quarantined the staff for 14 days. If they were patients and families with symptoms, especially family members in the home who were not caregivers, we asked them to leave the home or quarantine to a closed-off space away from the patient.”
With the pandemic’s unknown longevity, predicting the long-term impact of screening procedures will be difficult. While quality end-of-life care remains a focus for hospice providers, the coronavirus may have lasting effects on the way patients receive it.
“The delivery of [home] health care has forever been changed,” Branham told Hospice News. “It will be common for all front-line care providers to continue to use masks and gloves by those who touch patients in every care setting. The use of telehealth will continue to grow as our country tries to bounce back safely and protect the workforce, patients and families.”