Senate Bill Would Boost Hospice Respite Care During COVID-19

U.S. Sens. Sherrod Brown (D-Ohio) and Shelley Moore Capito (R-W.Va.) have introduced new legislation that would allow hospice patients to receive respite care in their homes during a national emergency, such as the ongoing COVID-19 pandemic. The bill would also extend the allowable length of stay to 15 days, up from the current limit of five days.

The COVID-19 Hospice Respite Care Relief Act of 2020 would allow the U.S. Department of Health & Human Services to grant hospice these flexibilities not only during the current pandemic but also during any future national emergency.

“The COVID-19 Hospice Respite Care Relief Act would provide some much needed flexibility for those providing, receiving, and depending on hospice respite care during this difficult time,” Capito said. “I’m proud to join together with Sen. Brown to introduce legislation that includes commonsense solutions like these, which are needed now more than ever as we all navigate our current reality.”

In typical circumstances, Medicare will cover respite care provided in an inpatient unit for as long as five days when their family caregivers need a break, becomes ill or must attend to competing priorities. During respite, patients can be admitted temporarily in a hospice facility, hospital or nursing home.

This has proven complicated for many providers during the pandemic, as inpatient capacity dwindled due to large influxes of COVID patients, as well as new limits on access to nursing home residents.

“We’ve been hearing from hospices about the need for more respite because there are people without places to go, who are ending up in those various inpatient settings who don’t have a safe discharge location,”Mollie Gurian, director of hospice, palliative, and home health policy for LeadingAge, told Hospice News. “The nursing home may not want to take them until they’ve spent 14 days in isolation or have a negative test. Also, caregivers might not be comfortable with them coming home after they have been in an inpatient setting out of COVID fears.”

Inpatient respite is one of the four levels of hospice care that Medicare covers, along with routine home care, general inpatient care and continuous home care. For 2020, the U.S. Centers for Medicare & Medicaid Services (CMS) rebased the payment rates, reducing the routine home rate by 2.6% and raising payment for the other three by that same amount.

The ability to extend length of stay could give hospices a small financial boost due to the rebasing, but this would be at least partially offset by the increased cost of providing respite care in the home.

“Inpatient respite is provided most of the time in nursing homes, and of course we’re not providing inpatient respite in nursing homes at this point,” Judi Lund Person, vice president for regulatory and compliance for the National Hospice & Palliative Care Organization told Hospice News. “That’s also why we needed the flexibility to either do it at home or do it in a hospice facility. The reimbursement will be the same, but doing it at home will require some staffing that might be in short supply at this point.”

Additional respite care may also become necessary for some patients during the pandemic in the event that the caregivers themselves become exposed or infected with COVID-19 or another illness.

“When the person who has stepped up to provide care to seriously ill hospice patients at home is not able to provide care because of their own illness, hospices need the ability to provide respite support for longer and in the patient’s own residence. In these unprecedented times, five days is inadequate for family members to return to their caregiving roles. We need to give hospices who already have mechanisms to provide respite care more flexibility beyond the support already available to hospice patients and their families,” said Margaret Cogswell, CEO of Hospice of the Panhandle.