Table 2.
Sources of Hospice Care Disruptions during the COVID-19 Pandemic
| Domain | Domain examples | Illustrative quotes |
|---|---|---|
| Delayed hospice enrollment | Cannot conduct face-to-face admission visit Staff shortage to conduct intake |
April 1, 2020, PCP MD: Called hospice intake to follow-up on status of referral, enrollment set for [3 days from now]; I talked to see if this could be expedited, seems they don't have capacity for earlier visits |
| Inability to conduct home visits | Staff unwillingness to enter homes Staff illness and quarantine Caregiver fear of hospice staff entering home |
April 10, 2020 RN: Patient is not eating or drinking; nurse assigned to see the patient Saturday has rejected the case because patient developed a cough; now they are concerned about possible COVID; RN cannot see COVID or possible COVID-positive patient; nurse has that right; visit moved to Monday |
| Lack of supplies | Shortage of PPE for home visits Shortage of oxygen for symptom management |
June 3, 2020, RN: patient's wife is stating patient is dying and breathing fast… patient's daughter arrived yesterday and staying in another apartment because it's hard for her to be there and watch… no oxygen in the home… hospice RN did video visit… said patient may not get oxygen in time if it's ordered now |
| Communication failures | Ambiguity regarding notification of the patient's passing Lack of follow-up with family |
May 26, 2020, PCP MD: Called hospice to discuss why our practice hadn't been notified [of patient's death] as I had confirmed on Friday with intake nurse that I wished to remain attending of record April 13, 2020, Covering NP: I understand hospice is extremely overwhelmed but communicating to daughter of status is vital |
| Strained caregivers | Caregivers unprepared for increased responsibility for care Challenges of training for end-of-life care virtually |
April 16, 2020, PCP MD: Hospice care manager states they can likely do IVF and [antibiotics] abx if [daughter] can be taught to monitor/remove; [husband] is unhappy with this plan but states he prefers it to taking her to ER. March 27, 2020, PCP MD: [caregiver] is feeling very overwhelmed by the waiting and unknown. Also missed [hospice RN] who is apparently in quarantine |
| Limitations of telehealth solution | Caregivers/patients unable to access technology Difficult to communicate sensitive topics and conduct caregiver training |
April 15, 2020, RN: Hospice offered virtual visit but son did not have technology April 3, 2020, PCP MD: [Hospice] will require signed consents prior to visit; RN tried to call patient's daughter to find out if she has e-mail to receive forms to sign and send back. Not sure if she is able to do so; [hospice] may not open the case… |
NP, nurse practitioner; PCP, primary care provider; MD, medical doctor; PPE, personal protective equipment; RN, registered nurse.