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On March 25, 2020, NHPCO leaders hosted a discussion updating hospices on the Covid-19 crisis. The discussion addressed several regulatory and legislative issues related to the virus as well as how hospices should respond and the ethical dilemmas that the community may face. We encourage you to view the full recording here.

Below, we’ve summarized 5 key high-level takeaways from the conversation:

 

 Guidance is Limited, So Good Documentation is Key.

There is still limited guidance from CMS on how hospices should handle some of the complex issues that have arisen due to the virus. However, NHPCO's executive dialogue did make clear that CMS understands that this is a critical situation and that hospice and palliative care facilities will need to do their best based on the situation presented to them.

One example that was discussed was what constitutes a visit in an age where physical contact can be risky. NHPCO expressed that CMS plans to issue revised guidelines on virtual visits, however, they did not have a timeframe in which they would do so. Because of this, the best guidance for hospices to take away was to examine each visit on a case by case basis and to reflect their decision both in their visit documentation and in the patient's plan of care. For instance, if a patient is located in a facility that is not allowing in-person visits, the plan of care should be updated to reflect the need for a phone or video visits instead.

Again, CMS suggested that there is some grey area as this rapidly changing situation unfolds. As always, good, accurate documentation will protect the hospice should any decisions be reviewed.

 

Lean on Your Emergency Preparedness Plan and Prepare it For What May Come.

Even the most detailed emergency management plan could not prepare you for the rapid spread of Covid-19. No organization was ready for the impact this disease would have on the community.

However, this does not mean that you should through your emergency preparedness plan out the window. The emergency plan was put in place to help guide communication and actions should an unforeseen event occur. Lean on your emergency preparedness plan to help guide you on how to get through this difficult time. Further, ensure that your staff, patients, and families are familiar with your emergency preparedness plan. NHPCO suggests monitoring staff and ensuring that they are able to repeat the plan back to you. A good plan will give you guidance to lean on you come across unexpected obstacles.  

Now is also a time to look at your emergency preparedness plan to ensure it accounts for everything you may need. While the Covid-19 crisis is at the top of most clinicians’ minds, hospices must be prepared for other emergency events. We are getting ready to head into hurricane season and have already seen tornados in certain areas of the country. Hospices need to take the time now to adjust their emergency preparedness plan for Covid-19 should a weather event occur.

Interdisciplinary Teams Puts More Tools in Your Toolbelt

As this unprecedented virus spreads, hospices may need to adjust the care that they deliver. Increased needs for grief counseling, care for families, and creative ways to stay connected may seem overwhelming as the need for care continues to grow. This may mean thinking creatively about the members of your interdisciplinary team and the skills that they can bring to your practice. 

Social works, clergy, or volunteers may have skills or experience that can be utilized to take on different roles than they may otherwise. A large interdisciplinary team can also help you extend your network to get supplies, volunteers, or any other support that you may need.

 

We’re In This Together and Should Look Towards Each Other

You’ve probably heard it a lot over the last few weeks, we’re all in this together. It may feel overplayed, but it is critical that we not only rely on each other but also look to one another for advice and guidance. If you’re uncertain about how to proceed on an issue, it’s likely that others are facing that uncertainty too. Healthcare organizations and community leaders have been happy to share best practices and guidance on how to proceed.

It’s also important to remember that this virus is impacting communities across the country in different ways. For communities that may not be hit as hard, it’s important to look to other communities to see how to prepare, what to prepare for, and communicate to your team what they should expect.

Hospice has a Role to Play Now and In the Future

Hospice has a key role to play in this crisis when it comes to caring for the sick and their families. Hospice organizations have always handled extremely delicate, often stressful situations with care and grace. The core of hospice is to help patients at a sensitive time in life and easing fear around the unknown. As this crisis unfolds, there will be a lot of fear for patients and families. Hospice has always provided a resource to guide people through fear and unknown. That is what this situation will call for.

As the nation moves through and away from this crisis, it is likely that we will look for new ways to provide care. The hospice communities’ interdisciplinary approach to care and focus on patient goals has the opportunity to be an example to all caregivers.

Conclusion

There may be difficult months ahead, but the hospice community is in this together. 

Keep up with the latest COVID-19 updates at NHPCO's COVID-19 resource portal here or on mumms.com here. 

Corporations across the country are rallying behind healthcare workers. We've compiled a list of benefits corporations are offering to healthcare workers in this time of need here. 

 

Please note this is updated as of March 25, 2020. Regulations and legislation is changing rapidly. Please consult with the latest CMS and CDC guidelines before acting or not acting on any information contained herein.

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