Hospices Struggle with Respite Care During Pandemic

The COVID-19 pandemic has complicated hospices’ ability to provide respite care. Limited access to nursing homes, fears of spreading the virus and rising demand are throwing wrenches into providers’ respite programs.

Congress is currently considering legislation that during any federally declared national emergency would increase the maximum length of stay for hospice respite care to 15 days, up from five days. If enacted, the bill would also allow hospices to offer respite care in the patient’s home. 

“This bill epitomizes policymakers ability to offer well thought-out legislative proposals that increase adaptability and flexibility for hospice patients, hospice providers and caregivers during a very uncertain time,” said Mark Slobodien, director of legislative affairs for the National Hospice & Palliative Care Organization (NHPCO). “It’s incumbent upon policymakers that they offer these types of solutions to their constituents.”

Medicare typically allows respite care to be provided on an inpatient basis for as long as five days when their caregivers become sick themselves or otherwise need a rest or address other priorities. Providers typically offer this care hospice facility, hospital or nursing home. Respite is one of four levels of hospice care that Medicare covers, along with routine home care, continuous home care and general inpatient care.

For the time being however, many hospices are between a rock and a hard place when it comes to respite care, in part because of the tremendous need spurred by the COVID-19 outbreak.

“One of the care challenges we identified early on during the pandemic is related to when a patient, their family, or caregiver came into contact with COVID or someone infected with the virus. Suddenly, everyone involved is scrambling to find appropriate housing and care for the patient. This is a tremendous challenge,” Jeff Lycan, president of the National Hospice Cooperative, told Hospice News. “The grueling demands of being a caregiver in the home are widely supported in peer-reviewed literature, and the personal stories often written about the role.To implement the coronavirus guidelines adds yet another layer of immense difficulty, personally and emotionally.”

Limited access to nursing homes has also been a factor disrupting respite care, Slobodien said. Oftentimes, beds in local nursing homes are simply not available, or the facilities are unable to complete sufficient COVID testing. 

With older adults suffering from chronic or life-limiting medical conditions among those most vulnerable during the COVID-19 outbreak, nursing homes across the country are restricting access to their facilities.

Nursing home populations are at the highest risk of being affected by the coronavirus, according to the U.S. Centers for Disease Control and Prevention (CDC). To address pandemic spread concerns, the U.S. Center for Medicare & Medicaid Services (CMS) announced critical measures to keep nursing home residents safe from exposure to COVID-19.

These obstacles are among the factors fueling industry support for the new Senate bill. 

“COVID-19 demands new flexibilities, as caregivers themselves could become exposed or contract the virus. Expanding hospice respite care shows appreciation and respect for selfless caregivers, and ultimately allows the individual to remain in their home for their final days,” said Kathryn Brod, President and CEO of LeadingAge Ohio.