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Wednesday, March 3, 2021

Hospice workers must be prioritized for COVID-19 vaccinations

As President Biden executes his $2 trillion plan to speed up COVID-19 vaccinations, it’s important to call attention to a vital group of front-line workers who are in need of greater protection.

Workers in the hospice care industry continue to have difficulty accessing personal protective equipment, therapies, and now vaccines. Yet vaccinating hospice workers, who are numerous and typically care for patients in their homes, would be one of the quickest and most-effective ways to slow the spread of the coronavirus. Home-based providers go from home to home in the course of their work. Their plea for protection and vaccination is not for themselves but for the many patients, family members, and informal caregivers they encounter every day.

There has been much debate about how to prioritize scarce vaccine doses. Should we do it by lottery? Age? Acuity? What strikes me about all these approaches is that they are focused on the people benefiting directly from the vaccine, not the people whom they might expose to the virus if they are not vaccinated.

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If we prioritize vaccinations for certain people solely based on their own risk, we miss our chance to beat a disease that is spreading through our community like wildfire. We do not put out wildfires by throwing water on fires here and there but through an approach designed to contain and prevent spread where it is most likely. When you think of it that way, the smart thing to do is to prioritize those who go from home to home to provide care for the frailest among us.

Prioritizing home-based workers, including hospice and palliative care workers, is not as easy as waving a magic wand. Vaccine planning efforts require the full support of the government. Some issues are logistical: Some vaccines require ultracold freezer units that, in many cases, only hospitals and healthcare systems can procure, and although the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices issued a decision on Dec. 1, 2020, to prioritize healthcare workers for Phase 1A vaccine access, the decision on prioritization of vaccine administration rests with state and local governments.

Regardless of regional decisions made about vaccine access, unvaccinated healthcare workers should not be asked to take unnecessary risks for themselves or their patients. For this reason, we must prioritize the vaccination of hospice and palliative care providers and other home-based providers on the front lines of the pandemic, caring for the nation’s most at-risk people in Phase 1A.

Home-based care providers often cover many miles as they care for our nation’s sickest and frailest. Take, for example, Nora T., a nurse serving in a small hospice organization in the Midwest. By noon, she has already been in six homes. None of her patients are known to be COVID-19 positive, but the danger is always there. The people Nora and her hospice colleagues tend to are all coping with life-limiting illnesses and are medically fragile. If they contract COVID-19, the precious time they have remaining will likely be cut short and spent isolated in a hospital bed, not in the familiar surroundings of home with family caregivers and loved ones present.

Much of the work of Nora and her team cannot be done remotely. To provide the optimum level of care that is the hallmark of hospice, she must visit her patients in person, and she needs to observe subtle clues not detectable by a digital device. To do her job well, Nora must talk frankly with family and caregivers and pay attention to nonverbal signals that will ensure the hospice’s care plan is comprehensive and appropriate to that family.

To date, hospice workers have been able to adjust their safety protocols with additional preventive equipment, quarantining when necessary, and some telehealth practices. But now that vaccination provides another layer of safety, it is critical for hospice and palliative care providers, just like hospital staff, to be given priority access. This is not only for their safety, but it’s for the safety of the patients, families, and community members they encounter across communities every single day.

More than 1.55 million Medicare beneficiaries avail themselves of hospice care every year. Many others receive home-based palliative care and personal care.

Collectively, the hospice, palliative care, and home-care sector is serving tens of thousands of patients with active COVID-19 infections, with over 60% of home care and hospice providers reporting infected patients in service. This underscores the need to prevent the spread by prioritizing vaccinations for front-line hospice and palliative care staff and the high-needs patients they serve.

Edo Banach is chairman of the National Coalition of Hospice & Palliative Care and president and CEO of the National Hospice and Palliative Care Organization.

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