Hospices have struggled to access patients in nursing homes since the initial stages of the novel coronavirus pandemic. As visiting restrictions start to lift with states reopening, many hospice providers remain cautiously optimistic about minimizing COVID-19 exposure risks for staff.
Closing doors to visitors and clinicians was a crucial move for many nursing homes working to protect vulnerable hospice patient populations at highest risk. With guidance recently released from the U.S. Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health & Human Services, nursing homes have begun to reopen and loosen restrictions on patient access for hospice providers. The guidelines lay out a three-phase approach to reopening.
“Restricting visitors was a very difficult decision, and likely the path back to allowing visitors will also be difficult,” said Erin Shvetzoff Hennessey, CEO of Health Dimensions Group, a consulting and management service provider to long-term care and senior living operators in Minnesota. “We agree with the CMS guidance released that reopening must be done taking into consideration cases in the community, staffing, [personal protective equipment (PPE)], and most importantly, testing. We expect that CMS recommendations being given to states and local governments took into consideration this variance.”
CMS outlined the factors that nursing homes must take into consideration when eliminating some restrictions, Hospice News’ sister site Skilled Nursing News reported. These include the number of COVID cases in the local area, the number of cases in the nursing home itself, adequate staffing, capacity of local hospitals, universal source control, and access to sufficient testing and PPE.
CMS strongly recommended that all staff and residents be tested regularly before nursing homes loosen restrictions. Although hospice providers throughout the nation face similar struggles in acquiring COVID-19 testing kits and PPE supplies for clinicians visiting patients in nursing homes, reopening plans will vary by state and local safety recommendations will vary as well. In the guidelines, CMS indicated that states have flexibility in implementing the criteria to reopen due to variances of how COVID-19 has impacted different geographic areas. Nursing homes are responding with different strategies to minimize risk and spread of COVID-19 among patients, including those receiving hospice care.
“We hope that local state variance is minimized to avoid provider and consumer confusion,” Hennessey said. “We have encouraged hospice providers to continue to be onsite when needed and to collaborate virtually when possible, but rely on [skilled nursing facility (SNF)] staff to complete services such as [activities of daily living (ADLs)] to minimize visitors. We also expect the use of digital technology to continue throughout the reopening process for both providers and families.”
Telehealth utilization, PPE supply levels and COVID-19 testing are just a few of the data points nursing homes are considering as they begin reopening, and the same goes for hospice providers hoping to gain improved access to patients in these settings. Nursing homes are required to compile COVID-19 data and report to both CMS and the U.S. Centers for Disease Control and Prevention (CDC), such as confirmed cases and death counts.
Despite potential roadblocks and concerns of infection risks, many providers say the state reopenings will ameliorate access to nursing home patients. More than half of hospice provider respondents to a Hospice News reader survey indicated that accessing patients in nursing homes would improve due to states reopening and would positively impact their organization’s operations.
“Overall, we have a positive impression of the balanced way in which CMS plans to reopen health care systems while allowing for state and local specificity in a dynamic situation that is truly unique for each of the communities across the country,” said Nick Westfall, president and CEO, VITAS Healthcare, a subsidiary of Chemed Corp., (NYSE: CHE). “Throughout the pandemic majority of hospice providers, including VITAS, have continued to be on the front line in the communities we serve. I believe this pandemic has clearly illustrated how valuable hospice and home care providers are to the overall healthcare continuum.”
A key factor for many hospice providers will be collaboration with nursing homes in terms of staff and patient protection policies. Increased communication could lead to improved relationships and quality care for patients across the care continuum.
“At VITAS, we are prioritizing our efforts to align with our health care partners to collaborate on how we can best fit with their ‘new normal’ to respond timely to their referral needs as they execute on their reopening plans,” said Westfall. “Through this pandemic we’ve been preparing our caregivers to be educated, committed and ready to respond to the evolving needs of our partners and the communities we serve. We’re hopeful that CMS and other agencies continue to remember the unique delivery of care the hospice community provides to the patient’s bedside, whether that is at home, hospital, nursing home, assisted living facility, etc., to account for any guidance provided to these facilities regarding testing.”