COVID-19 Surge Pummeling Hospice Operations, Finances 

A strained workforce and patient accessibility continue to plague hospice providers nearly a year into the COVID-19 pandemic. The recent uptick of cases has further pressed hospice providers, with concerns growing about their ability to respond as the year comes to a close.

Another surge of the pandemic is hitting the United States almost 11 months following the initial federal emergency declaration, with the U.S. Centers for Disease Control & Prevention (CDC) reporting nearly 1.2 million new cases in the last week alone. To date, more than 260,000 people in the United States have died as a result of COVID-19.

“We’ve had our medical staff on what we call our ‘surge schedule’ for almost two months,” said Matthew Kestenbaum, M.D., chief medical officer of Virginia-based home health and hospice provider Capital Caring Health. “It takes a physical and emotional toll as COVID numbers decreased but never went away. People have been working very hard for a long time, and now we’re likely to see yet another period of needing our ‘surge schedule’ as we get into the teeth of this again.”


Daily trends of new COVID-19 cases have exceeded 100,000 since the start of November, with the CDC reporting more than 165,000 cases yesterday alone. While increased availability of testing resources may be a potential contributing factor of increased case identification, the number of cases nevertheless reflects a massive increase in the number of actual cases with no signs of a slow down on the horizon.

Balancing staff scheduling needs with increased demand for hospice and palliative care has pressed providers during the pandemic. Staff burnout has forced many hospices to reevaluate their policies around paid leave/paid time off (PTO) as employees respond to childcare needs with school closures and remote learning, as well as falling ill to the virus themselves or quarenting after possible exposure.

Limited availability and rising costs of personal protective equipment (PPE) challenged hospices in their ability to maintain and support a healthy workforce in the early days of COVID-19. Competition for these resources has since improved, but the upswing of cases has led to unease about continued availability.


“We were having trouble even obtaining masks. When the pandemic hit, we thought we needed to stock up just as everybody was trying to stock up at the same time,” said Jacque Burklow, chief operating officer for Hospice of Midland, an organization that serves five counties in the state of Texas. “We weren’t getting all the things we needed from our medical suppliers so we had to reach out to other sources. This last week is the first time in weeks if not months that we’ve actually received alcohol gel from our medical supplier.”

Prices for masks, gloves and sanitizers remain high, with numerous hospices facing financial difficulties absorbing costs. Several hospices have collaborated with community members and organizations in search of protective supplies as they compete for resources to protect staff and minimize risk of exposure to protect high-risk patient populations.

PPE has been essential to remaining in touch with patients and their families, with accessibility another point of contention during the pandemic.

According to a survey conducted by the National Hospice and Palliative Care Organization (NHPCO) in June 2020, 84% of hospice and palliative providers reported denied access to patients in nursing homes and 65% reported difficulty accessing patients in other facility-based settings such as assisted living facilities. Accessibility has continued to top the list of concerns as hospice providers struggle to reach patients in these settings, with many facilities keeping their doors closed to help diminish risk of spread.

Hospices have stepped up outreach to referral partners and strengthened partnerships to continue accessing patients in facilities and in the home.

“We really want to be supportive of our hospitals, our assisted living and of our facilities who have really had probably greater challenges than we have,” said Burklow. “Only nurses could come in at one time before they opened back up a little bit and now social worker and chaplain visits for psychosocial and spiritual needs are essential visits as well.”

In many cases, providers are relying on telehealth to communicate with facility-bound patients and their families, according to Burklow.

Unknowns encircle the field as the pandemic continues, with hospice and palliative care providers seeking to absorb lessons learned from COVID-19 experiences as they brace for potential impacts and fallouts of another wave. Supporting the workforce will be crucial to survival in the battle against pandemic forces.

“I think we’re prepared now from a preparedness perspective,” Kestenbaum told Hospice News. “It’s taken quite a while for us to acquire reusable half-face respirators, but we now have them for our entire staff. I’m confident that they will be very safe during the remainder of this pandemic. What worries me is the emotional and physical toll this time around. There’s really been no place to go away and decompress.”

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