Hospice and Covid-19

End-of-life care for dying patients poses new challenges during coronavirus public health emergency

Providing end-of-life care to terminally ill patients requires a delicate balance of compassion and discernment to meet the medical, emotional and spiritual needs of patients.

Delivering the right mix of those hospice services has become even more challenging during the Covid-19 pandemic, when hospice agencies must find the right balance to meet patient needs while limiting contact.

A flurry of confusing new regulatory waivers from the Centers for Medicare and Medicare Services (CMS) this spring has increased the challenge, as hospice providers try to sort through what is allowed during the public health emergency.

“This is a difficult and confusing time for hospice agencies,” said Heather Calhoun, Director of Special Projects, Appeals and Hospice for Home Health Solutions, a nationwide consulting firm for home health, hospice and long-term care.

“They’re not sure what CMS expects as far as remote visits, or how to bill for them. They’re not sure what changes need to be made for QAPI (Quality Assessment and Performance Improvement) programs. And in some cases, agencies may not even have access to all their patients,” Heather said.

Hospice patients and their families who are frightened by the risk of Covid-19 infection may be reluctant to allow hospice workers into their homes, Heather said.

Nursing homes and assisted living centers across the nation have responded to the harrowing numbers of deaths among their at-risk residents with lockdowns to restrict or forbid all visitors. Even hospice workers who provide services to alleviate pain, discomfort and anxiety to the terminally ill patients within these facilities may find themselves locked out.

“Hospice providers are very concerned about how to handle these situations,” adds Annette Lee, founder of home health and hospice consulting firm Provider Insights. “They want to know what to do when a patient in a facility, or even in their own home, has declined in-person visits, and the comprehensive assessment is overdue."

Hospice webinar June 2

Annette and Heather have teamed up to provide answers to many hospice questions during a webinar offered by Home Health Solutions.

“Hospice Care During a Pandemic” will take place at 11 a.m. CST, Noon EST on June 2, and will include a Q&A session at the conclusion of the presentation to allow providers to pose their questions.

The webinar will review new telehealth rules, explain what is and isn’t allowed for remote visits, cover QAPI changes and more.

“As a bonus, attendees will receive a guide to success for your emergency remote state survey on infection control,” Annette said.

To register and read more about the webinar, visit the registration page by clicking here.

Pointers for patient access

Whether it’s a frightened family or a careful facility which is blocking the agency’s access to patients, Heather and Annette say the key to resolving the issue lies in providing reassurance about the steps the hospice agency is taking to mitigate risk of infection.

They recommend hospice agencies have written information prepared to present to facility administrators or family members.

“These may be brochures or letters, “Annette suggests. “You might have one letter prepared to go out to the facility administrator, and a different letter ready to go out to the family of a patient. While they will be different letters addressing slightly different concerns, each will essentially be a list of ‘What We Are Doing About Covid-19’ – showing what you are doing at your agency to mitigate risk.” Information to provide to facility administrators might include:

  • What CMS has said about allowing hospice workers in facilities

  • Infection control training provided to your agency personnel

  • How your agency plans to meet patient needs while limiting unnecessary risk

  • Your agency’s ability to provide some bereavement or social services via audio-visual calls

“Remember that the administrator wants to see the level of your agency’s commitment to protect all the patients in that facility,” Annette said.

In a similar fashion, the letter for the family of a patient being seen at home would need to explain how agency personnel have received infection risk training and address the personal protective equipment to be worn during in-person visits.

“What would you want to know if this were your family?” Annette said. “That’s what needs to go into the written information your agency provides to worried families.”