Nationwide, skilled nursing facilities are employing a mixed bag of rules and restrictions to control the spread of the deadly COVID-19 virus, including some that apply to hospice providers.

As variant strains drive up morbidity and mortality, facilities are again paying sharper attention to the safety of individuals entering their buildings — though generally not to the extent that was seen during 2020.

Accessing patients in facilities was a top concern for hospices during 2020 and early 2021. Many providers could not access facility-bound patients at all and, in turn, saw drops in referrals. While in many cases hospice nurses were allowed in, most patients did not receive the full benefit of the interdisciplinary care model.

While the 2020 restrictions were a national trend, the current rules vary from market to market due to differing state laws as well as facilities’ own policies.

“With the most recent [COVID] wave — and some of the access restrictions that are going back into place with certain health care facilities out across the country — I think we’re going to continue to see the ongoing impact inside of hospice that we’ve seen starting in 2021,” Nick Westfall, CEO of VITAS Healthcare, a subsidiary of Chemed Corp. (NYSE: CHEM), told Hospice News. “Those access restrictions going into place, it’ll still cause some disruption inside of many hospice providers census throughout 2022.”

New York and California, two states with large hospice markets, are among those that have limited facility access, Hospice News sister site Skilled Nursing News reported.

California now requires nursing home staff to not only be vaccinated, but also to receive a booster. The state also introduced additional testing requirements for others who enter facilities who have not gotten the third shot.

New York state implemented similar requirements, as well as a rule that all who visit the facilities wear “surgical” masks and have a negative COVID test within the previous 24 hours.

Rhode Island now requires visitors to be vaccinated or to show proof of a negative rapid test from within the previous 48 hours, or a negative PCR test result from within the previous 72 hours.

“With COVID-19 case rates elevated in Rhode Island and across the country, we need to take steps to safeguard the members of our community who are more vulnerable,” said Rhode Island Director of Health Nicole Alexander-Scott, M.D. “If you have a loved one in a nursing home or assisted living facility, the best way to visit safely with that person is to get vaccinated.”

Though the health care worker vaccine mandate from the U.S. Centers for Medicare & Medicaid Services (CMS) has been a contentious issue, it may level the playing field in terms of facility access.

If a provider is in compliance with the federal requirement, then it follows that their staff would also meet state- and facility-specific vaccine rules.

Nevertheless, the restrictions pose some challenges, including the expense and dwindling supply of COVID-19 tests and further reliance on telehealth.

For the time being, strong communication channels with their facility partners would serve hospices well, as requirements in some regions routinely shift, depending on infection rates.

“We’re seeing that change week to week from facility to facility,” William Finn, CEO of Hospice of the Western Reserve, said. “We’re hoping now that northern Ohio is peaking with Omicron and will start to come down, and we’ll see that relief.”