Concerns continue to mount among hospice providers regarding their ability to reach grieving families heading into a third year of the coronavirus pandemic. Many hospices moved their bereavement care services online to keep a safe distance amid rising demand, but long-term plans are difficult to formulate given rampant uncertainty about how the outbreak will proceed.
Hospice providers must offer bereavement counseling for a minimum of 13 months following a patient’s death, per U.S. Centers for Medicare & Medicaid Services (CMS) requirements. Hospices often extend grief care available throughout their entire communities, regardless of whether the deceased was a patient.
COVID-19 sparked a growing need for bereavement care, with many hospices seeking out ways to meet community needs by applying additional resources and new methods. Just shy of two years following the initial federal emergency declaration on March 13, 2020, the deadly virus has claimed upwards of 820,350 lives nationwide as of Dec. 29, according to recent data from the U.S. Centers for Disease Control and Prevention (CDC).
“We’ve had to learn, adjust and adapt with COVID,” Heather Harold, bereavement coordinator for Iowa-based Generations Hospice Care, told Hospice News. “The biggest thing is just to continue to reassure our communities that we will protect them and we’ll protect ourselves. COVID really hurt individuals’ support systems because they weren’t getting together with friends or families or having traditional funeral services that would normally be a way to help them through their bereavement and the grief process. That has really hindered these families a lot. With the COVID variants and not knowing what the future holds, there’s not an end in sight.”
Emergence of the delta and omicron variants have been at the heart of rising cases and deaths across the country, with many regions experiencing “substantial or high levels of community transmission” in the last weeks of 2021, according to the CDC, which previously indicated in August that nearly 99% of deaths in recent months occurred among the unvaccinated. Currently 78% of those eligible nationwide have received at least one vaccine dose, according to CDC data.
Traditional bereavement services are provided through in-person counseling sessions, meetings with families, support groups, grief camps and other services that were halted to curb spread of COVID-19. The pandemic has reshaped how hospices provide bereavement care, with many turning to virtual settings and implementing new technology platforms to continue supporting families.
“We had to do a lot of telehealth [and] we have found that some families are comfortable enough with that and don’t want extra people in their homes to expose them,” said Shannon Hazen, director of professional services at Generations. “I do believe that this will become something that we’ll use long-term.”
Iowa-based Generations Hospice Care serves Crawford, Harrison, Monona, Pottawattamie and Shelby counties, many of which contain rural populations. Virtual telehealth and phone visits have often been the only continued, regular and consistent grief support system for many families in these communities experiencing loss during the pandemic, according to Harold.
Hospices are weighing further long-term telehealth investments against an uncertain regulatory future. CMS extended a number of flexibilities for telehealth on a temporary basis during the pandemic to reduce the likelihood that patients, families or clinicians could spread the virus. President Trump in 2020 issued an executive order instructing the U.S. Department of Health & Human Services to review temporary telehealth flexibilities to determine which could be made permanent, but to date the agency has not announced any decisions on the matter.
“We’re concerned that over time that it’s going to be where CMS is not going to allow [telehealth],” said Harold. “Right now, that’s not a problem, but we don’t know what the future holds on that.”
Though telehealth systems have been an avenue of continued support, families experiencing the loss of a loved one have contended with unprecedented levels of increased anxiety, depression, loneliness and isolation as the outbreak continues.
Earlier in the pandemic, satisfaction with telehealth ran high, but that trend may have taken a dip towards the close of 2021. A study from J.D. Power identified a number of factors that could be driving the dip in satisfaction, including a limited range of services, inconsistent delivery and access, confusing technology, unexpected costs and a lack of health care provider details. The study examined direct-to-consumer and payer-sponsored telehealth services across the country.
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