Hospices Struggle to Access Patients in Nursing Homes Amid Pandemic

By Holly Vossel | March 20, 2020

With older adults suffering from chronic or life-limiting medical conditions among those most vulnerable during the COVID-19 outbreak, nursing homes across the country are restricting access to their facilities. As a result, hospice providers have experienced difficulty accessing their patients in nursing home settings.

Nursing home populations are at the highest risk of being affected by the coronavirus, according to the U.S. Centers for Disease Control and Prevention (CDC). To address pandemic spread concerns, the U.S. Center for Medicare & Medicaid Services (CMS) announced critical measures last week to keep nursing home residents safe from exposure to COVID-19.

“About 10% of our 70 nursing homes here in Pinellas County [Florida] are not allowing hospice personnel access to our hospice patients residing in nursing homes,” said Scott Kistler, vice president of strategy and business development for Empath Health, a Florida-based hospice and palliative care service provider. “And that’s not particular to us. It’s a widespread problem.”

The new CMS recommendations advised nursing homes to “significantly restrict visitors and nonessential personnel, as well as restrict communal activities inside nursing homes” to protect seniors at the highest risk for complications from COVID-19.

As nursing homes work to protect both patients and staff in accordance with the CMS and CDC guidelines, volunteers, visitors, therapists, and various other contractors are included in the restrictions. While CMS Administrator Seema Verma indicated that hospice workers among those considered essential personnel who should be allowed access, it’s unclear how many nursing homes are aware of this specification.

Though the access problems are widespread, they are not universal. Some nursing homes are continuing to let in hospice clinicians. 

“Facilities can establish their own guidelines on restricted visitation,” said Jeri Krauss, an independent geriatric nurse consultant in Texas specializing in hospice care . “Most that I have talked to are allowing family and care workers to see residents on hospice care. Workers and family wear personal protective equipment (PPE) during the visit.”

To continue providing patients with end-of-life care during the COVID-19 pandemic, hospices are working with nursing homes to gain access and reassure them of protective measures being taken against the risks.

“Our partners in nursing homes and assisted living facilities are continually working to ensure the safety of their patients and staff,” VITAS Healthcare indicated to Hospice News in an email. “As part of this advocacy, we ensure our clinicians follow adequate hand hygiene and adhere to facility screening procedures, as well as working with facility leadership to incorporate CDC and CMS guidance. Educational material was also developed to instruct on proper cleaning and disinfection procedures.”

VITAS Healthcare is a subsidiary of Chemed Corp., (NYSE: CHE).

With a shared focus on quality care for vulnerable patients, some nursing homes and long term care providers are working to expand their definition of essential personnel to include hospice providers. 

“Hospice providers are a key part of the senior care health team, and we work in collaboration to enhance quality of life in the final months of life,” said Erin Shvetzoff Hennessey, CEO of Health Dimensions Group, a consulting and management service provider to long-term care and senior living operators in Minnesota. “We need hospice providers to continue to provide the holistic support to our residents and their families as they always do.”

Ramping up protective measures has been among the most vital actions hospices are taking to reassure safety and reduced risk when entering nursing home facilities.

“Most of our nursing homes here are screening and temperature-screening staff that are coming in,” said Laura Mosby, vice president of compliance and organizational excellence with Empath Health. “All staff going into nursing homes and assisted living support are going to be required to wear procedural masks and gloves if they’re providing direct care to a patient. The flip side to that is that we will blow through our supply. It’s now created a different concern: Will we be able to sustain enough medical supplies to meet this requirement?”

With this concern in mind, the CDC issued new guidance on the use of masks, gowns and face shields including suggestions on what to do if in crises shortages when supplies are exhausted. Nursing homes and assisted living communities are encouraged to significantly conserve masks and gowns in order to extend availability of remaining PPE supply.  

Additional measures involve providing nursing home patients with reassurance to continue receiving the care they need.

“We are communicating with our residents to remind them that their needs will continue to be met and that essential health care services, including hospice services, will be continued without interruption,” said Shvetzoff Hennessey. “They are also reassured that all visitors to the community, even those for end-of-life visits or essential care workers, are being screened for illness in an effort to reduce their exposure to COVID-19.”

Equally as important to accessibility is the well-being and health of hospice staff accessing nursing homes. As staff entering facilities and patient homes take precautionary action to protect patients, their own health is just as vital to safeguard colleagues and their families.

With unprecedented school closings during the COVID-19 outbreak, hospice staffing support is extending beyond physical health protection and into personal life needs as well. Many families who rely on school-provided meals are experiencing food shortage issues. Additionally, staff are experiencing financial strain with unemployment numbers on the rise as businesses nationwide shut down during the pandemic.

“You have to take care of your staff and help them feel confident and competent, they then have the resources they need to be able to take care of patients and their families,” said Mosby. “One of the things that we’re working on right now is putting together some resource materials for our staff to give them access to whatever they need to be able to continue to work and live with the least amount of disruption as possible.”

As the coronavirus pandemic surges, hospices and nursing homes need to continue a collaborative partnership and provide patients with accessible care.

“At times like this, it requires those of us who are in leadership roles to really address those fears and anxiety within our staff and our volunteers so that they can in turn calm the fears and anxieties of our patients and families,” Kistler told Hospice News. “The population that we care for, many of these people would not be able to survive this virus, and also to the patients who may contract the virus and to their families who would be challenged by that. It really is a call to action to continue providing the best care possible in these vulnerable populations.”

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