Lessons Learned: The Intersection of End-of-Life, Telehealth, and a Pandemic

End of life and palliative care have long been known as high-touch models of interdisciplinary care. The spiritual, psychosocial, and physical comfort that are at the heart of the hospice philosophy require proximity. Understanding the needs of the dying and chronically ill require nuance and attention to detail: noticing how a patient experiencing discomfort grimaces may lead to a nurse fine-tuning pain medications. Subtle nonverbal responses to questions about faith or anxiety can allow a social worker or chaplain to recognize a need.

In a pre-pandemic world, hospice professionals excelled at using in-person visits with patients to provide the holistic style of care resulting in some of the highest CAHPS and patient satisfaction scores in the Medicare program. However, COVID required hospices to pivot significantly with goals of continuing to provide care in an environment where in-person visits weren’t always possible.

Telehealth and tech come to hospice

When hospitals and long term care facilities went into lockdown, hospices had extreme difficulty accessing patients to provide routine care. Nurses couldn’t get to the bedside to perform assessments, and chaplains could no longer gather with families to pray and offer counsel. The pandemic changed the game.

What a Risk-bearing Entity Should Expect from Their Hospice Partner

During the public health emergency, the Department of Health and Human Services (HHS) issued waivers allowing many visits to be performed digitally within certain requirements. Hospices quickly pivoted and adapted to continue serving patients when in-person visits weren’t an option. The solutions were never meant to be permanent but nevertheless the widespread use of technology changed the hospice paradigm for the long haul. Below are three key lessons learned about how hospices could leverage technology to provide higher-quality care and keep patients where almost all wanted to be during the pandemic- the place they considered home.

Three tech lessons learned

1. Telehealth is an add-on, not a replacement. Hospices performed virtual nursing visits with patients over tablets and computers when in-person visitation wasn’t possible. By having a skilled nursing administrator bring tech to the bedside, hospices could provide care and services remotely. Telehealth visits paved the way for hospice team physicians and other advanced practitioners to be able to consult on patient needs while cutting down on travel time. Extending the abilities of the interdisciplinary leadership allowed hospices to manage symptoms before they flared up, keeping patients safely in place.

2. Properly utilized, technology can help the Interdisciplinary Team. Hospices hold weekly case interdisciplinary group meetings (IDG) where patients are discussed from the perspective of all disciplines. These meetings usually happen in an office environment, but the pandemic forced hospices (as so many others) to embrace virtual meetings. COVID-19 gave hospices the room to develop policies and protocols to hold IDG virtually when needed, in a compliant manner. While in-person IDG yields good results, the virtual options can support hospice teams in rural areas or when extreme weather events may occur, allowing for continuity of care.

3. Hospice telehealth requires coordination. Hospices can’t simply ‘ping’ a patient on their iPhone or tablet. When virtual visits are required to provide or extend care, hospices need strong facility or hospital partners to help schedule visits and be in-person to allow the remote hospice team member to be as fully ‘virtually’ present as possible. This requires coordination, planning, and infrastructure.

While many hospice professionals are glad to be getting back to something approaching ‘normal’, it’s clear that telehealth was a crucial component of allowing hospice-eligible patients to receive the comfort and dignity that hospice could provide, even during a global pandemic.