Hospice in the Time of COVID-19: Findings from the NAHC National Survey

May 27, 2020

FOR IMMEDIATE RELEASE

Media Contact: Thomas Threlkeld Director of Communications 202-547-7424/tom@nahc.org

Hospice in the Time of COVID-19: Findings from the NAHC National Survey

Strong majorities of hospices in the United States that responded to a survey by the National Association for Home Care & Hospice (NAHC) have admitted COVID-19-positive patients on to service, but also anticipate a decrease in annual revenues in 2020.

Hospices from nearly every U.S. state and territory, including several multi-state providers, provided valuable insights into the impact the COVID-19 public health emergency (PHE) is having on hospice care delivery, admissions/referrals, operations and financials through their responses to the National Association for Home Care & Hospice’s (NAHC) Hospice COVID-19 Impact Survey. The survey, which was conducted over the first three weeks in May 2020, sought information on a broad range of issues, including the extent to which hospices have employed telecommunications technology to help meet patient care needs.

Given the challenges of anticipating how issues associated with the ongoing pandemic will play out over the remaining months of 2020, it should be noted that the survey findings reflect participants’ best estimates, based on current experience, of the anticipated impact of the PHE on costs, revenues, operations and admissions/referrals for the year. However, the findings offer important evidence of the challenges that hospice providers across the nation are encountering as they seek to meet the needs of terminally ill patients and their caregivers during an unparalleled time.

Patients Served/Referrals: Nearly two-thirds (61 percent) of hospices that responded to the NAHC survey have admitted confirmed COVID-19-positive patients on to service. At the same time, more than half of respondents saw a decrease in admissions during March 2020 as compared with March 2019. More than 25 percent of respondents have seen a decrease in admissions of 15 percent or more, although two-thirds (66 percent) have maintained their conversion rates on patient referrals. Despite that, nearly 71 percent of survey participants have seen a decrease in referrals/admissions from nursing facilities, 63 percent a decrease in referrals/admissions from hospitals, and nearly half (49 percent) have seen a decrease in referrals from the community. Perhaps not surprisingly, the vast majority (roughly 77 percent) increased their use of personal protective equipment (PPE) in order to serve patients and family members, more than half (roughly 52 percent) saw an increase in short-stay patients, and nearly half (44 percent) saw an increase in the severity of patients admitted to service.

Financial Impact: Sixty percent of hospices in the survey anticipate a decrease in annual revenues during CY2020, with just under 30 percent (28%) expecting a decrease of 15 percent or more. At the same time, over 80% of the hospices expect costs for CY2020 to increase, with nearly 25 percent expecting costs to increase by 15 percent or more. PPE topped the list of items that contributed to increased costs/lost revenues, followed by staffing costs and reduced referrals. Just over 44 percent of hospices have seen a reduction in fundraising revenues, which are frequently utilized to cover otherwise unreimbursed costs. Based on the survey, hospices have made a number of operational changes in response to COVID-19; 46 percent of respondents have acquired Small Business Administration (SBA) or other loans to carry them through the pandemic, while 41 percent have decreased direct patient care staff. Nearly 37 percent have reduced administrative staff. Relative to PPE, almost 35 percent of hospices believe that they need to have between a 10 and 20 day supply on hand to meet foreseeable needs, while close to 27 percent plan to have a 20-to-30-day supply in order to meet forthcoming need.

Use of Technology-based Visits: Not surprisingly, more than 95% of hospices have had existing patients refuse visits due to fears associated with risk of exposure to COVID-19. And while hospices have been able to provide technology-based visits to continue patient care in some cases, nearly 24 percent of the hospices in the survey were able to substitute virtual visits in only limited or no cases. Maintaining in-person visits for patients residing in nursing facilities has been (and continues to be) one of the major COVID-related challenges for hospice providers; only 12% of hospices have been able to provide most of the in-person visits they want to perform. The new flexibilities to provide technology-based visits has addressed some of the challenges faced by nearly 65 percent of survey respondents in providing services to facility-based patients, but only 4 percent of hospices indicated that use of telecommunications technology has addressed all of the patient access issues in facilities.

A large proportion – more than 84 percent — of hospices participating in the survey are using telecommunications technology to provide services to Medicare hospice patients and a similar proportion (approximately 82 percent) use two-way audio-visual communications (among other technologies) for patient care. Not surprisingly, when asked which of the many flexibilities (including relaxation of certain Conditions of Participation) permitted by the Centers for Medicare & Medicaid Services (CMS) during the PHE has made the biggest difference in easing stresses on their hospice operations, over 62 percent identified use of telecommunications technology for visits or to fulfill the hospice face-to-face requirements as the most impactful.

“The data supplied by hospice organizations is invaluable, and paints a much clearer picture of the many challenges that hospices across the nation are working to overcome during the public health emergency,” said NAHC President Bill Dombi in response to the findings. “This information will be crucial as we continue to work with Congress and the Administration to craft solutions that support the continuing provision of vital hospice care to vulnerable patients and their loved ones despite the complexities that COVID-19 present.”

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About National Association for Home Care & Hospice (NAHC)

The National Association for Home Care & Hospice (NAHC) is the voice of home care and hospice. NAHC represents the nation’s 33,000 home care and hospice providers, along with the more than two million nurses, therapists, and aides they employ. These caregivers provide vital services to Americans who are aged, disabled, and ill. Some 12 million patients depend on home care and hospice providers, who depend on NAHC for the best in advocacy, education, and information. NAHC is a nonprofit organization that helps its members maintain the highest standards of care. To learn more, visit nahc.org.