Many Hospices Need to Step Up Disaster Planning

A large contingent of hospices may be unprepared to cope with a large-scale disaster or a future pandemic.

Operators need to be prepared to deliver care and support their communities’ responses to catastrophic events. Increasingly, this factors into compliance. In 2017, the U.S. Centers for Medicare & Medicaid Services (CMS) expanded a Condition of Participation pertaining to disaster preparedness planning. Last year, The Joint Commission implemented similar requirements for hospices.

However, the COVID-19 pandemic exposed gaps in preparedness when it comes to hospice and palliative care. Generally, this has not been treated as a priority by other emergency management entities as well, Dr. Janna Baker Rogers, a board-certified physician in both palliative and emergency medicine with West Virginia University Medical, said at the American Academy of Hospice and Palliative Medicine (AAHPM) Annual Summit.

“Overall hospice and end of life care was given too little consideration and disaster management policies and actions have been enacted by the larger response community,” Baker Rogers said. “They were at best insufficiently supportive and at worst partially obstructive to provision of hospice care in disasters.”

COVID-19 caused widespread disruption across the health care system, including among hospices.

For hospice and palliative care providers, many were unable to reach patients in facilities and at times could not provide care in some homes, Baker Rogers indicated. Referrals to hospice were frequently delayed, and respite care was also impossible in some instances due to nursing home restrictions. Transitions of care were also adversely affected, she said.

The pandemic also came with exacerbated workforce shortages and a lack of supplies such as pharmaceuticals and personal protective equipment. Government and other aid programs often prioritized hospitals with little attention paid to hospices, Baker Rogers stated at the conference.

A lack of training is another issue that became apparent during the outbreak.

“Literature emerging out of the COVID-19 pandemic suggests that hospice providers lack training and education in disaster preparedness,” Baker Rogers said. “Despite regulations, hospices often lack any form of disaster preparedness. And even when plans were in place, hospices and home health agencies struggled to implement them in their practice and struggled to develop impromptu strategies.”

Nevertheless, hospices can have an important role to play in disaster response, in addition to maintaining continuity of care for their current patients.

In times of visitation restrictions, for example, hospice personnel can act as liaisons between patients and families, Baker Rogers indicated. They can also provide education, services and advocacy related to grief and bereavement in mass-casualty incidents, as well as assist with public health surveillance and reporting.

Hospice staff can also be a source of support for clinicians in other settings, helping to stave off burnout, Baker Rogers said.

“These elements align in many ways with both actual roles that hospices have already undertaken to support their communities in disasters and also with much of the literature around the potential roles that hospices could play,” Baker Rogers said. “Recognition of the importance of palliative and end of life care as provided by hospices in disasters is increasing.”