Initially hitting states like Louisiana, New York and Washington the hardest, hospices in these and surrounding regions quickly took measures to protect the high-risk seriously ill and dying patients most vulnerable to COVID-19. The coronavirus pandemic has since stretched into new “hotspot” regions across the nation during the summer months, with hospice providers continuing to seek ways to minimize infection and exposure risks.
Hospice and palliative care providers alike have adapted infection control and prevention methods in light of the pandemic’s shift throughout the United States. As state closures lifted with dropping cases during spring of this year, hospices were stressed about the potential for a rise in COVID-related cases and deaths, bracing for impact in summer. Concerns were validated with tracking reports from the U.S. Centers for Disease Control and Prevention (CDC) as the total number of COVID-19 cases and deaths spiked in states like California, Florida, Georgia and Texas.
“The recent rise in cases has affirmed the need for the infection control practices we implemented at the beginning of the pandemic per guidance from the CDC and the Georgia Department of Public Health (GDPH),” Jessica Hutcheson, intake coordinator of Georgia-based Affinis Hospice, told Hospice News. “In all [service] areas we have identified a trend of shorter life expectancy in patients on hospice services who test positive for COVID-19, and referrals for end-of-life care for patients with COVID-19 often occurring in the last hours to days of life. We continue to monitor our infection prevention and control processes in order to promote the health and safety of the patients and families we serve, as well as of our employees.”
The Midwest joined the fight against the pandemic’s spread with jumps in COVID-related deaths as states began to reopen. Early in July, the City of Chicago issued an Emergency Travel Order which mandated a quarantine period for those entering and leaving the state from high-impact areas, including neighboring Wisconsin.
“While initially our cases in Wisconsin were lagging behind other states in the country, we have seen consistent growth in cases since early June,” said Jennifer Flugaur, assistant vice president for quality and compliance of Agrace Hospice & Palliative Care in Wisconsin. “As a state, we saw the highest death rate in May and thankfully, that number has not climbed at the same proportion as newly diagnosed cases. The plan now is to ‘stay the course’ and continue to be proactive and responsive to the needs of our patients and our communities.”
Rolling with the pandemic’s punches has involved continuous evaluation of clinical and operational procedures, with providers strained to both protect and support patients, families and staff under re-amplified concerns of infection risk. Personal protective equipment (PPE) shortages have remained a top concern for hospice providers struggling to acquire limited supplies among inflated costs.
“PPE availability and managing staffing shortages in the event numbers continue to increase is on the minds of hospices throughout the country,” said Flugaur. “In response, developing and modifying PPE protocols in addition to closely monitoring staff ‘burn rates’ will be essential in the coming months. Remaining nimble in staffing practices and having policies surrounding return to work will also be important in the event [that] COVID-19 numbers in the areas we serve continue to rise and we see staff exposure-rates and/or illness rates rise.”
Maintaining a healthy workforce has been an ongoing challenge for providers, with hospices reevaluating policies and procedures to allow for staff childcare needs and quarantine periods for those exposed or infected with COVID-19. Staff symptom monitoring and testing have become part of the new norm for many organizations to reduce risk of transmission and spread.
“We put into place requirements for symptom monitoring twice daily for staff early on,” said Flugaur. “We have continued to modify our approach and created an online application so staff can more easily report their symptoms prior to their shift. This coupled with expectations for all staff to wear an appropriate face covering while at work and encouraging physical distancing through the utilization of virtual meetings and ‘work from home’ policies have helped us reduce the risk of transmission within our organization.”
Several hospice providers have leveraged technology to reach patients and their families. Some of the temporary flexibilities to expand telehealth implemented during the pandemic are set to be made permanent by the U.S. Centers for Medicare & Medicaid Services (CMS). Heat map technology has also come into play, allowing hospices to track geographic regions at greatest risk of COVID-19 impact.
“Recent waivers and flexibilities have allowed for the utilization of telehealth, which was not on option before in the hospice service space,” said Hutcheson. “The telehealth platform allows for increased visual interaction with patients to aid in the trajectory of their care, as well as promote social distancing and identification of unnecessary exposure risks. Telehealth is also a tool that is used to support the patient’s emotional and spiritual well-being by facilitating visual interaction with family members and support service members, like chaplains and social workers.”
Given the intricacies involved with end-of-life care, hospices may be among the health care settings that are able to sustain themselves through the pandemic’s waves, with flexibility a key factor according to Hucheson.
“Hospices are well-known for being flexible and being able to quickly adapt to whatever is happening around us,” Flugaur told Hospice News. “As an industry, we have continued to advocate for the patients we serve and ensure that no matter the diagnosis, we are there to provide the support that our patients and their families need. It is always an honor to provide hospice support, but to ‘show up’ when the world seems to have stopped is pretty incredible and something we should all be proud of.”