Anxieties abound among hospice providers regarding a potential deluge of COVID-19 cases as states begin to reduce social distancing and shelter-in-place restrictions, even as many hope for easier access to patients in nursing homes and assisted living facilities.
Most U.S. states are to varying degrees lifting public safety measures such as stay-at-home orders, business closures and restricted access to public spaces such as beaches and state parks. Many fear that this could lead to a strong resurgence in cases, which in turn could lead to a large influx of infected patients and increased risk of exposure for staff.
“I think it creates a little bit more element of fear, because we now know we sort of lived in this cocoon for eight weeks, if you will, and we knew people weren’t going to large gatherings. We knew people weren’t out there exposing one another to the virus,” Karen Carrig, president and CEO of Wisconsin-based Rainbow Hospice told Hospice News. “Opening up the states so that people can go to bars and restaurants and large venues where there’s lots of people does not feel like a benefit to our organization. I will say that if this works, and we open up and we don’t get a big spike in cases in a couple of weeks, that certainly will go a long way towards continuing to open up the state more and more. We just have to rely on people to use common sense and continue social distancing.”
Rainbow Hospice’s home state of Wisconsin has been among the quickest in the nation to roll back social distancing rules. The state’s Supreme Court earlier this month struck down Democratic Gov. Tony Evers’ extension of Wisconsin’s shelter-in-place orders and enforcement of social distancing measures. Four of the court’s seven justices decided in favor of objections to the orders from Republicans in the state’s legislature.
To date the United States has had more than 1.7 million COVID-19 infections and close to 100,000 deaths, according to the U.S. Centers for Disease Control and Prevention.
The pandemic has put a huge strain on hospices as they struggled to acquire sufficient amounts of necessary supplies and personal protective equipment (PPE). They were also faced with the need to quarantine staff who were exposed to the virus, while providing for paid leave and contending with unusually limited access to patients. Many hospices nationwide had difficulty accessing patients in nursing homes due to pandemic-related restrictions and some families were reluctant to let clinicians into their residences due to fears of infection.
These problems remain top-of-mind as hospice providers watch their states reopen.
In a recent survey of providers conducted by Hospice News, 61% of respondents said that organizations should be very concerned about business disruption due to the pandemic, and 36% reported being moderately concerned. Their biggest worry as restrictions come down is increased exposures to staff, with 40% indicating that this was their top concern. About 14% were most worried about access to PPE if rates of infection trend upwards.
“This is not going away. This coronavirus is going to still be around most likely in the fall in the winter, and PPE is still going to be a problem. Many of us are trying to beg, borrow and steal from suppliers to try to find the best rate for various sizes of hospices, be it nonprofit or for profit. This is going to be a continuing battle,” Tim Rogers, president and CEO of the Association for Home & Hospice Care of North Carolina (AHHCNC), said. “As you reopen, the numbers are going to go up even more. It’s going to put more pressure on nursing homes and on hospices working with nursing homes. I think you’re going to see greater likelihood of community-acquired COVID infection.”
Rogers is also president and CEO of the South Carolina Home Care & Hospice Association.
Even in light of the potential drawbacks, some hospice providers are optimistic about the removal of restrictions, hoping for easier access to patients who dwell in nursing homes and assisted living facilities.
Among respondents to Hospice News’ survey, 62% said that loosening restrictions could lead to better access to patients in those types of facilities, and more than half indicated that reopening would have a positive impact on their businesses.
In either case, hospices will have to continue to maintain strict infection prevention and control protocols as well as frequent and effective communication with referral partners and facilities that house their patients.
“Hospices have been wonderful at adapting, and hospices continue to work diligently to provide that amazing care,” Shannon Pointer, vice president of hospice & palliative care for AHHCNC, told Hospice News. “Things will continue to change. The concerns around being able to have adequate PPE have been there from the beginning and will continue to be there, as well as concerns for being able to safely provide the wonderful care that hospice provides. Hospices need to be able to have adequate communication, collaboration and access to patients, specifically those in facility settings.”