The COVID-19 pandemic has hit many hospices hard both financially and from an operational standpoint.
Many providers have wrangled with supply shortages, dwindling access to personal protective equipment, rising prices, reduced referrals and very limited access to their patients in nursing homes during the outbreak. Hospices also have had to redesign many of their processes from bereavement care to volunteer training and patient visits to incorporate video-conferencing technology.
Hospice News sat down with Rafael Sciullo, president and CEO of Florida-based Empath Health, and Marci Pruitt, vice president of Suncoast Hospice, an Empath subsidiary, to talk about the ways the pandemic impacted their operations.
Could you describe what your organization’s experience has been during the pandemic? Have you had an influx of COVID-positive patients?
Sciullo: We formalized a structured task force right from the beginning that meets daily and then reports to the organization. Presently, we have seven patients that are COVID positive.
We have had some patients who have bounced back from the virus. Certainly we have had those. We have had three employees [out of 1,100] that have tested positive for COVID-19. Two of them are now resolved and returned to work. We still have one employee that is positive, and that is for all of Empath Health, including all of our affiliates.
We certainly were affected by the nursing homes in our county that did have to close for a period of time. So we moved some of those patients to one of our care centers, and we do have a couple of specialized areas [for COVID patients] in our care center.
Pruitt: We have three care centers, and we decided to try to congregate the COVID patients in what we call our North County Care Center. That is the newer of our buildings, and we had built in some negative pressure rooms. We’ve had almost all of our [COVID] patients go to that particular care center, and we have been able to accommodate the needs for our county.
Some of our long term care facilities have had outbreaks. In one particular facility where we had a handful of current hospice patients, we brought them into one of our care centers even though they were not COVID-positive. They are in a residential level of care until they can return to their nursing home when the Department of Health gives this facility the all-clear.
Under what circumstances would patients be transferred to a care center? Were there certain factors that you considered?
Pruitt: I wouldn’t say there’s one size fits all answer to that question. We have 70 nursing homes in this county, and some of them have had zero COVID patients. Some of them have had very many COVID patients. It really depended on the facility.
The facilities here are required to report their COVID status to the state and to the Department of Health. At one point in time, the Department of Health stepped in and one facility was told that they have to entirely evacuate the premises. We were helpful with that facility in making those placement arrangements for our patients.
I don’t know when the virus will peak in terms of long term care. I think that will become clear when the number of cases start going down.
Can you talk about how the pandemic has affected Empath financially?
Sciullo: We did see some effect in our April and May referral activity, and much of that was connected to the restrictions with the nursing homes. We were still obviously able to provide care for them through telehealth and through going in person with our nursing home team. I am very proud of our employees; our care didn’t skip a beat.
Where we did see some changes was that so much of the attention of the professionals in the nursing homes and the physicians was focused on COVID-19. We did see some decline in referrals. That was primarily in April and somewhat in May.
Our average daily census continues to be strong and certainly increased from last year. But as far as referrals, we have seen an impact.
Can you tell me about your experience in ramping up telehealth?
Sciullo: We actually have been talking about telehealth in our strategic plan for this year even before COVID-19 arrived with all of its challenges. I think certainly this kind of sped up that process for us, but we did have to increase our resources naturally. There was a very different focus now.
I do think that at the end of the day, when you look at all the challenges that the virus has caused — both for us in direct care and for the world at large — the opportunity is that it really has enhanced that hands-on direct, compassionate care. We’re going to go back to doing things the way that we did them [prior to the pandemic], but now we have this enhanced approach to our care through telehealth. I think of those family members that may or may not be able to be here on site with their loved ones. I just think that there’s a real enhancement that has come about because of it.
How comfortable did patients seem with the transition to telehealth? Were they comfortable using the technology?
Pruitt: Particularly in long term care, they were ecstatic to have telehealth as an option for them to not only connect with us and other disciplines in the organization, but also with their family members. These folks have not been allowed to see their families, and we were able to come in with our telehealth capability and help them connect with their loved ones. We have some very heartwarming stories about the patients seeing their family members’ faces for the first time in weeks.
Sciullo: There was a daughter of a patient who lived in New Jersey that had called me. Her mother was one of our patients, and she could not get there to visit her. She very carefully recounted to me the evening before her mother died. The nurse went in there specifically and put her mom on the phone and just engaged in a conversation with them. She said that she felt she otherwise never would have had that opportunity to say goodbye, and that is so important to me.
Florida is the process of reopening businesses and reducing some of the restrictions stemming from the pandemic. Have you seen any impact on your business or your patients as a result of the reopening, positive or negative?
Sciullo: Certainly [reopening] must be a phased in. We’re in phase one of the reopening as put forth by the [Florida] governor.
First of all, we’re very pleased that our volunteers are beginning to come back. They’re seeing some of the restrictions being lifted and feel that they can return. We have missed them greatly in our organization, and they provide a valuable service for us in so many areas. That phased-in reopening and bringing them back is a positive thing.
I think the other thing is that some individuals are now returning back to work. Even though we have not had employment affected here in any way at Empath, obviously our employees have spouses and partners that may have been not able to work because of the stay-at-home order. I think that having some individuals return to work has been good for our employees if it has affected their households in any way.
Will this reopening process help improve access to patients in nursing homes?
Pruitt: Restrictions on visitation to long term care haven’t been lifted yet, and that’s when we’ll really see the impact. Right now, access is very limited as far as how many people can go in and out of the facilities. When that lightens up a bit, that’s when we will see some changes.