A year and half into the novel coronavirus pandemic, hospices are growing increasingly concerned that emerging variants of the virus will severely impact their operations, workforce and finances. As infections surge, particularly among the unvaccinated, many communities are reinstating precautions that have been relaxed as more people get their shots.
More than 610,000 lives have been lost to COVID-19 in the United States since the deadly virus first hit, according to the U.S. Centers for Disease Control & Prevention (CDC). The pandemic’s spread across the country began to slow as vaccines began to roll out earlier this year, but cases have been climbing once again in another surge of COVID-19. Nearly 80,000 COVID-19 cases were reported in the last week alone, with the virus claiming 370 lives nationwide in the past 7 days, according to the most recent CDC report. Nearly 99% of the recent deaths occurred among the unvaccinated, according to the CDC.
“We’re very worried about the variants. About three weeks ago, we started seeing the impact right around July 4, when we noticed our COVID numbers hang up just a little bit. Now they’re ticking up dramatically,” said Laura Mosby, chief compliance officer of Florida-based Empath Health. “Florida is a hotspot for the country, and it is really concerning for us.”
COVID-19 cases in Florida tipped above 110,400 last week, according to a recent Florida Health Department report, causing the hospice, home health and palliative care provider to reinstate some of the precautions it had loosened up on around staffing protocols, according to Mosby, who stated that vaccines will be an important part of getting a handle on the latest pandemic surge.
About 58% of Empath Health’s staff is currently vaccinated, Mosby told Hospice News. The company is considering implementing a mandatory vaccine policy. Despite the increased risk, Empath is not seeing a substantial influx of new COVID cases, which Mosby attributes in part to the company’s strict personal protective equipment (PPE) measures.
“We’re starting all over again, but we’re hoping we can nip this before it gets too widespread,” Mosby said.
PPE is essential to protect patients and staff. These products also represent one of the largest financial and operational concerns during the outbreak, with hospices facing limited supply and high costs for masks, gloves, clothing covers and sanitizing materials and equipment. While this far into the pandemic most providers have acquired a sufficient supply, this has taken a financial toll on hospice revenue.
Public masking guidelines began to loosen as more of the country became vaccinated. Vaccinated people have been allowed into public spaces without masks in recent months, but these guidelines have since changed in light of the new B.1.617.2 (Delta) variant circulating across the country.
Earlier this week the U.S. Centers for Disease Control and Prevention (CDC) announced updated masking guidance for vaccinated individuals, recommending that they wear a mask in public indoor settings or areas of substantial or high transmission.
“If clinical staff, patients and family members are unvaccinated, there is significant risk of contracting the Delete variant, [which] is more contagious than the other virus strains,” Jennifer Kennedy, senior director of regulatory and quality for the National Hospice & Palliative Care Organization (NHPCO), told Hospice News. “The Delta variant is a respiratory virus and spreads when aerosolized particles are discharged from an effective individual. Staff need to use PPE for protection against this type of infection.”
Some providers require staff to become vaccinated while others have kept it optional. Some companies have mandated that unvaccinated staff don additional PPE and follow additional safety and infection procedures. Hospice providers nationwide are rethinking their staffing policies and infection control procedures, including the prospect of mandatory vaccines.
Hospice providers with optional vaccination policies have had to balance the need to protect staff, patients and families while also allowing employees to use their own discretion in regards to personal choices, as well as any medical or religious exemptions. More patients and families are requesting that only vaccinated staff provide care. This also creates challenges for employers who cannot provide patients with their staff’s protected personal health information.
A push for vaccines can be a point of contention for hospice leaders, even causing a sort of “ethical conundrum,” according to Mosby.
“Our challenge is overcoming whatever barriers there are preventing people from being vaccinated, whether those are cultural, fear-based or other reasons,” Mosby told Hospice News. “It’s about trying to help overcome some of those barriers, or you get to a place where we mandate it and just put a hard line in the sand. However, that can have ramifications, though. It has a lot of tentacles to it that we have to think through carefully. While it still may be the best decision to have contingency plans for all the potential ramifications of going that way, it’s not something we can do lightly or quickly. We are very seriously considering it, much like a lot of other health organizations have done, and we are in the process of thinking it through.”
Amid the intense stress of the pandemic, employers are stepping up efforts to support staff. Empath Health is focusing more resources to help address the psychological and mental health needs of staff, Mosby said.
The availability, access and education around vaccinations is vital for hospices to step forward as COVID-19 continues, according to Judy Wooten, president and CEO of Arkansas Hospice. The hospice provider has tightened up on loosened restrictions around masking and social distancing in response to the Delta variant’s spread.
Supporting staff throughout the pandemic has weighed heavily on the minds of many health care providers as turnover continues to rise. A little more than 20% of health care workers have considered leaving the field as a result of stress brought on by the outbreak, and 30% have contemplated reducing their hours, according to a recent study published in JAMA Network Open.
Workforce shortage issues have plagued the hospice industry for years across a range of disciplines, including nurses, licensed independent practitioners, case managers and aides.
“If we have learned anything over the past 16 months, it’s to expect the unexpected and remain flexible,” Wooten said. “Due to the rise in cases and the increased transmissibility of the delta variant, we have reimplemented masking and social distancing practices that we had been able to relax briefly. This impacts those who have been vaccinated more than those who have not, since there was a short period when fully vaccinated employees could work together without wearing a mask.”
The variants also have hospices worried about the potential return of tight restrictions on who can enter skilled nursing or senior housing facilities, which has severely impacted patient care and providers’ bottom lines.
Nursing home and long-term care facilities closed their doors to hospice interdisciplinary teams in an effort to curb the pandemic’s spread, with some only allowing nurses to enter on a limited basis. In addition, referrals from these organizations dropped precipitously and only recently began inching toward recovery.
Still, providers have cause for some degree of optimism.
“Nursing homes and other long-term care facilities have high vaccination rates compared to the general population. This will hopefully slow down the number of lockdowns we may see from the delta and other variants,” Wooten said. “Perhaps the biggest difference for hospices now is the availability of nurses. As we moved through spring 2020, hospitals were placing nurses on furlough and forced into layoffs. Now we have a shortage of nurses as hospitals are near or at capacity and offering substantial hiring incentives, making it hard for hospices to compete for staff.”
The variants also signal the continued reliance on telehealth. The U.S. Centers for Medicare & Medicaid Services (CMS) expanded allowable use of telehealth through a number of emergency waivers. During periods of national disaster, the U.S. Department of Health and Human Services has the authority to waive regulatory requirements under section 1135 of the Social Security Act.
In May, a bipartisan group of U.S. senators reintroduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2021. If enacted, the bill would expand Medicare coverage of telehealth service and make some of the CMS waivers permanent.
The importance of telehealth is unlikely to diminish in a post-pandemic landscape, according to NHPCO President and CEO, Edo Banach.
“We hope the worst is behind us, but we’ve got a variant that’s making its way across the country and the world. We want to think about opportunities for innovation and what we’ve learned over the course of the last 16 months, [and] an example is telehealth,” said Banach during a recent NHPCO virtual conference. “How we utilize technology to help people and at the same time, leverage the human capital we have. What defines us is how we step in, how we step up and the quality of care.”
This article was written by Holly Vosell on August 2nd , 2021 and can be found here. Please be sure to visit HospiceNews.Com for more articles written by Holly and other quality contributors.