By Nick Westfall / Special to Healthcare Facilities Today

Nothing about COVID-19 has been easy. The move to reopen healthcare facilities during the coronavirus pandemic presents specific challenges, benchmarks, and opportunities.

Specific considerations surround the gradual reopening of healthcare facilities that have been shuttered or severely limited in their ability to provide routine care during the pandemic:

• Unusually high levels of concern, scrutiny, and anticipation by any person who uses, provides, inspects, works for, or interacts with a healthcare provider/facility
• Ever-evolving questions about how, when, and under what circumstances reopening should be phased in to provide safe, measurable healthcare for patients, employees, healthcare partners, and entire communities

Hospice providers stand ready to support the nation’s nursing homes, assisted living facilities, and hospital emergency departments (ED), three facility settings where hospice care is provided or considered to be the next best option for care when in-home hospice care—representing the vast majority of end-of-life care—is not possible or preferred. 

Hospice’s interdisciplinary approach to care, along with the protocols that have been instituted since the spring of 2020 to ensure intimate-yet-safe hospice care during COVID-19, offer targeted solutions for facilities as they reopen toward a “new normal.”

Expertise from hospice providers is available on multiple fronts, from evidence-based realities of patient-centered hospice and palliative care, to the “softer” skills of grief/bereavement support and conversations with seriously ill and dying patients (and their families) about their preferences for the care they want—and do not want—as the end of life inevitably approaches.

Hospice’s value to nursing homes, ALFs, EDs

Nursing homes and ALFs, for example, can benefit from a newfound awareness of hospice eligibility among fragile residents and patients, allowing them to make timely referrals to hospice/palliative services. Eligible residents and their families can benefit from comfort-focused hospice resources, interdisciplinary care teams, and virtual technologies to help them stay connected, educated, and updated, while facility staff are freed to focus on daily care. 

Hospital-hospice partnerships can help EDs leverage timely referrals to transition hospice-eligible patients quickly to comfort-focused care at home or a more appropriate setting. Hospice expertise in the ED allows doctors, nurses, and staff to focus on true emergencies, allocate their resources and beds accordingly, and refer patients with advanced illness to the most appropriate post-ED setting. 

Likewise, expertise in goals-of-care conversations and advance care planning has emerged as an essential skill during COVID-19. Often without training, many front-line ED workers or nursing home employees have found themselves in situations for which they were not r prepared, whether holding the hand of a dying stranger or connecting a dying resident with his family members via Zoom to make decisions about a ventilator or do-not-resuscitate order.

Hospice care teams specialize and engage in these conversations with patients and families daily. Trained hospice physicians, nurses, social workers, and chaplains can guide these difficult but necessary conversations, easing that burden for already overworked, stressed teams in partner facilities. Hospice partners can ensure that the appropriate legal documents and medical forms accompany patients’ decisions, and they can time these heartfelt conversations earlier in the process of diagnosis and decline to avoid last-minute, made-in-the-moment-of-crisis decisions. 

In all healthcare settings, staff members can benefit from ongoing grief support from hospice bereavement specialists. Many hospice providers now offer virtual and phone support groups for those suffering grief and loss from COVID-19, including front-line healthcare workers, surviving family members, children, veterans, spouses, and others.  

The Interdisciplinary Care Model in Non-Hospice Settings
The delivery of hospice care is based on the interdisciplinary team model, defined by a nurse, physician, aide, social worker, chaplain, and volunteer who manage patients’ symptoms and pain while providing psychosocial support to their families and caregivers.

The hospice team brings unique expertise around emotionally difficult and challenging COVID-19 issues, particularly the anecdotes of patients or residents dying alone, or healthcare workers forced into roles as surrogate family members and friends at a dying stranger’s bedside.

Applied to nursing homes, assisted living facilities, and hospitals, the hospice model provides a framework that can help them reopen safely while continuing to focus on their unique care delivery.

As they explore hospice partnerships, healthcare facilities should seek expertise in key areas:

• End-of-life Care Experience and a Strong Focus on Safety, including a commitment to safety for the hospice staff, facility staff, residents/patients, other healthcare partners/vendors, and visitors. These commitments should be reinforced by time-tested safety protocols, training, oversight, technology, and metrics. 
• Oversight, Inspection and Survey Expertise to help meet all new and appropriate standards surrounding ongoing monitoring and heightened COVID-19 scrutiny. Expertise will be critically important for oversight of safety, training, PPE protocols, infection control, facility use, and visitor screening.  
• Robust, Transparent Testing Procedures and Data, defined by a dual willingness to coordinate testing among all healthcare partners and share results to reassure residents/patients, staff members, partners, vendors, and inspectors that facilities are safe. 
• Expanded Telehealth Capabilities for Resident/Patient Care, Education, Connections, and End-of-life Conversations, including virtual platforms that support medical care, staff education and training, emotional and spiritual support from social workers and chaplains, and grief/bereavement support for patients, families, and healthcare workers. 
• Expertise in Goals-of-care Conversations and Advance Care Planning to ensure that the care residents and patients receive is the care they have defined—before a crisis has developed—as the care they prefer. 

Perhaps the most profound lesson to be learned since the start of 2020 is the value of collaboration and partnerships among healthcare providers who are on the front lines. 

Based on their experiences and willingness to remain flexible as they’ve provided end-of-life care in a challenging and changing healthcare environment, hospice partners can bring tremendous value to other healthcare facilities as they reopen their doors to patients in a marketplace and practice environment that has new rules and heightened expectations. We can meet those challenges together.

Nick Westfall is president and CEO of VITAS Healthcare.