The COVID-19 pandemic, by contrast, has been a different phenomenon. A virus that spread around the world in less than six months has taxed the US healthcare system, upending nearly everything that was once routine and predictable about caring for extremely sick patients.

 

Yet the current pandemic has also taught us that experience and flexibility matter. Many of the policies, strategies, and multi-phase preparedness plans that we deploy at VITAS Healthcare in anticipation of a hurricane or in the wake of a mass shooting, for example, serve well as operational roadmaps that inform and shape our ability to continue providing hospice care despite COVID-19 challenges, shortages, and risks.

 

COVID-19 also reminds us that adaptability and open mindsets can help the healthcare profession react, re-tool, and reframe how critical healthcare is delivered. This virus has forced us to do so in a very short time.

 

At VITAS, adapting to the pandemic has created care scenarios that are entirely new to the hospice profession. Flexible innovation has demanded it, and the Centers for Medicare and Medicaid Services’ (CMS) decision to allow telehealth for hospice care has supported it:

• Conducting head-to-toe examinations of a patient by video chat, with a family member or caregiver guiding the smartphone or tablet, is now a reality for our admissions nurses as they evaluate patients for hospice eligibility.

• A virtual tour of a home hospice patient’s living area helps hospice nurses assess whether a hospital bed, walker, patient lift, or bedside commode should be delivered to the home.

• Face-to-face goals-of-care conversations are replaced by video chats in which physicians, patients, and family members explore care-related wishes and document difficult-but-necessary decisions about ventilation, do-not-resuscitate orders, and comfort-focused care.

 

These new ways of coordinating and delivering care are supported by tried-and-true disaster preparedness protocols in place at all of our service locations for events like hurricanes, wildfires, and mass shootings. They have helped us coordinate and deliver care in the era of COVID-19 even as we develop new protocols for the virus’ new challenges. As examples:

• In all 14 states and the District of Columbia, VITAS instituted mandatory education for VITAS care teams on infection control and care procedures consistent with CMS and the U.S. Centers for Disease Control and Prevention guidelines. This includes securing appropriate PPE for our employees to provide hands-on care. Each of our 48 programs has a dedicated infection control specialist.

• Nationwide, VITAS teams adhere to screening protocols, visitation policies, and direct patient-care guidelines at our partner hospitals and care facilities. Often prevented from entering facilities, our care teams increasingly rely on telehealth to communicate with our healthcare colleagues, patients, and their families.

• A VITAS task force participates regularly in nationwide conference calls so that on-the-ground managers, hospice clinicians, and executives can stay collectively updated on federal, state, and local guidelines and announcements. Information is relayed regularly to all 12,000-plus VITAS employees via companywide emails and intranet.

 

Through all of the challenges this pandemic has presented, our promise of 24/7/365 availability remains constant. New tools and protocols now ensure that VITAS patients can continue to receive care at home, even if the new definition of care involves limited in-person visits by the hospice team and regular telehealth check-ins.

 

Likewise, we can admit patients directly from the hospital emergency department to general inpatient hospice care or to hospice care at home, supported by ongoing telehealth consultations with hospital staff, updates for family members, and psychosocial support for patients from chaplains and social workers.

 

Healthcare in the COVID-19 era is developing into a combination of enhanced protocols and flexible innovation, a continually evolving strategy that enables us to best help our patients and their families when they need us most.