The Pandemic’s Lasting Hospice Referral Impacts

Pandemic-related headwinds that strained hospice referrals may have lingering impacts on how providers are approaching their community outreach and marketing efforts.

Referrals from assisted living and skilled nursing facilities represent a large portion of hospice patients, along with hospital and health system referrals. Limited access to facility-based settings during the pandemic caused hospice referral volumes to drop significantly, posing financial and operational challenges for many providers.

Though some hospices have begun to see improvement as restrictions eased with the end of the public health emergency (PHE) on May 11, others continue to struggle toward a referral rebound.


The “new normal” of hospice referrals may be shifting, according to Susan Ponder-Stansel, president and CEO of Alivia Care. Hospice referral streams may be seeing lasting shifts as a result of trends that pre-dated COVID, including growing patient preferences to receive end-of-life care in the home setting, she said.

“A lot of providers are trying not to make any irrevocable decisions, because it is a strange time with nothing as it was,” Ponder-Stansel told Hospice News. “There’s a lot less demand for facility-based general inpatient care and more demand for continuous home hospice care. Nursing home populations are down, we’re seeing shorter lengths of stay and more acutely ill patients getting referred much later. We don’t know if that’s going to even out in this first year post-pandemic.”

The pandemic’s temporary impacts could “drastically change” access that patients, families and referral sources have to high-quality, home-based hospice care, according to Jeffrey Marsh, senior vice president and chief growth officer at Compassus.


Hospitals and health systems that saw patient demand skyrocket amid high levels of staffing burnout and turnover have increasingly recognized the value of diversifying with home-based hospice and palliative care services, he said.

“The pandemic solidified home-based care as essential to the future of health care,” Marsh told Hospice News in an email. “Since then, we have seen more hospitals, health systems and payers recognize the need to offer diverse care options that begin and end in the home. Hospice and palliative care providers have the opportunity to re-engage in the communities they serve and reestablish these services as essential components of care.”

Hospice providers stand to benefit from revamping their approaches to building sustainable referral streams, according to Ponder-Stansel.

This includes communicating how hospices can help ease the pain points that referral sources such as skilled nursing facilities, hospitals and health systems are still experiencing. For instance, balancing clinical capacity against patient demand, reducing rehospitalizations and lowering care delivery costs, she stated.

“We’re seeing hospitals still struggle with their patient volumes and staffing,” Ponder-Stansel said. “When they’re in basic survival mode, a lot of that downstream pressure makes it harder for them to focus on things like identifying who needs palliative or hospice care. We’re concentrating a lot more on describing the capabilities of our services to help them. We’re asking them about patients bouncing in and out of the emergency room that they wish weren’t and trying to be more of an asset, versus a sales or marketing outreach. It’s thinking about that referral relationship differently.”

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