Ensuring Continuity of Care: How Hospice Providers Can Support Nursing Homes as the COVID-19 PHE Expires

By Christa Roman, Director, Long-Term Care Partnerships, VITAS Healthcare

Nursing homes face new hurdles and challenges following the expiration of the COVID-19 public health emergency (PHE) on May 11.

Throughout the crisis, the Department of Health and Human Services implemented various waivers and modifications to support healthcare facilities. One significant provision that directly impacted skilled nursing facilities was a temporary waiver of the three-day hospital stay requirement for Medicare fee-for-service patients.

With the reinstatement of this requirement, some nursing facilities anticipate a slower admission process that may cause delays in providing essential care to residents. Although others believe the impact will be minimal, it is crucial to acknowledge the potential challenges and prioritize continuity of care.

The Importance of Care Coordination

Transition—between providers, out of the hospital, or into a new facility—presents risks to the patient each time it happens. In 2018, the Agency for Healthcare Research and Quality found 2.3 million readmissions of Medicare recipients within 30 days of a care transition, at an average cost of $15,500 per patient.¹

A patient who is rehospitalized or taken back to the emergency room in this situation often receives costly, over-medicalized care that contributes to their discomfort and functional decline without extending their life.

As nursing home staff continue to care for a resident with increasing complications, they can benefit from the support of a team focused on whole-person care coordination—the foundation of the hospice model.

A trusted hospice partner is uniquely positioned with complex clinical and psychosocial services to help long-term care facilities ensure a smooth care transition for residents with serious illness. The hospice interdisciplinary team coordinates support based on a resident’s individualized plan of care and in consultation with the resident’s attending physician or physicians, while also addressing the emotional and spiritual needs of the resident and their loved ones.

No Need to Wait

Hospice eligibility is determined by a physician’s prognostication of the resident’s disease trajectory and is not subject to the three-day hospital stay requirement. Critically, this enables a nursing home resident to receive a high level of care focused on alleviating their disease burden without returning to a hospital.

When considering a hospice referral, sooner is better for residents facing serious illness: Studies show the greatest benefits are enjoyed by patients who are enrolled in hospice earlier in their disease trajectory and remain on service for a longer period.²

• Patients who received early hospice care were 10 times less likely to be admitted to the hospital during their final month of life than their non-hospice peers.³
• Emergency room visits were five times more likely for late hospice patients than early hospice patients in the last month of life.³

Nursing homes benefit from the support of a hospice team by:

• Maintaining their resident census and reimbursement/payment stream for non-hospice services
• Avoiding high patient turnover that can burn out staff
• Improving short- and long-stay quality metrics
• Maintaining positive relationships with referring hospitals

Why VITAS Is a Trusted Partner

When evaluating potential hospice partners, nursing home staff should consider the hospice provider’s ability to deliver care at a level that will meet the residents’ complex clinical, psychosocial, and spiritual needs as they approach the end of life.

• Can the hospice provider take on residents who require complex modalities to treat their aggressive symptoms?
• Can the hospice provider deliver these interventions in the resident's preferred setting of care?
• Does the hospice provider offer high-acuity care for residents experiencing distressing and/or difficult-to-manage symptoms such as shortness of breath, pain, or infection?
• Will the hospice provider support your staff around the clock with 24/7 access to dedicated hospice clinicians?
• What education and training will the hospice provider offer to your nursing home staff to help them care for your residents with serious illness?

VITAS Healthcare can provide all of these services and more for nursing homes and their residents. Through a partnership with VITAS, nursing homes gain access to evidence-based protocols, quality improvement tools, and ongoing support.

By providing comprehensive education and training programs, VITAS equips nursing home staff with the necessary knowledge and skills to address the unique needs of residents with serious illnesses. This educational support empowers staff to deliver high-quality care, improve resident outcomes, and enhance resident satisfaction.

1. Agency for Healthcare Research and Quality [AHRQ], 2018.

2. National Association for Home Care & Hospice. (2023). The Value of Hospice in Medicare. NORC at the University of Chicago. https://www.nahc.org/wp-content/uploads/2023/03/NORC-Value_Hospice_in_Medicare_Slides.pdf

3. “Family Perspectives on Hospice Care Experiences of Patients with Cancer,” Journal of Clinical Oncology; February 1, 2017; 35(4):432-439. Kumar P, Wright AA, Hatfield LA, Temel JS, Keating NL; University of Pennsylvania, Philadelphia; Harvard Medical, Boston; and Brigham and Women’s Hospital, Boston.